title: Late-onset bile leakage after hepatic resection.
abstract: BACKGROUND
  Postoperative bile leakage can be a serious complication after hepatic resection. Few studies have analyzed patients according to the time of onset of bile leakage. We analyzed differences between patients with early- and late-onset bile leakage after hepatic resection and assessed clinical characteristics and outcomes in patients with late-onset leakage.
  
  
  METHODS
  Between 2008 and 2010, 1,009 patients underwent hepatic resection at 4 participating university hospitals and 2 community hospitals. Fifty-two patients (5.1%) with postoperative bile leakage were divided into an early-onset group (<2 weeks after surgery, n = 34) and a late-onset group (≥2 weeks after surgery, n = 18). Patient characteristics and outcomes were collected prospectively and analyzed retrospectively.
  
  
  RESULTS
  The proportion of patients who underwent intra-abdominal placement of a drainage catheter was significantly less in the late-onset group than the early-onset group. All 18 patients in the late-onset group developed intra-abdominal infection, and 2 died of sepsis. The proportion of patients who underwent invasive treatment (abdominal paracentesis, endoscopic biliary drainage, or second hepatic resection) was significantly greater in the late-onset group than in the early-onset group. The time to resolution of bile leakage was significantly greater in the late-onset group than the early-onset group.
  
  
  CONCLUSIONS
  Patients should be monitored carefully for bile leakage for several weeks after hepatic resection, because late-onset bile leakage can cause serious complications. Intra-abdominal infection should also be treated as soon as possible, because it may induce refractory bile leakage with serious complications.
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. Electronic address: kaibori@hirakata.kmu.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.affiliation: Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Junzo
authors.initials: J
authors.lastname: Shimizu
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Yong Kook
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noda
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Dono
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Nozawa
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile / Q000382:microbiology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult