title: Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy.
abstract: Bile leakage (BL) remains a common cause of major morbidity after open major liver resection but has only been poorly described in patients undergoing laparoscopic major hepatectomy (LMH). The present study aimed to determine the incidence, risk factors and consequences of BL following LMH.
  
  
  
  All 223 patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were retrospectively analysed. BL was defined according to the International Study Group of Liver Surgery, and its incidence and consequences were assessed. Risk factors for BL were determined on multivariate analysis.
  
  
  
  BL occurred in 30 (13.5 %) patients, and its incidence remained stable over time (p = 0.200). BL was diagnosed following the presence of bile into the abdominal drain in 14 (46.7 %) patients and after drainage of symptomatic abdominal collections in 16 (53.3 %) patients without intra-operative drain placement. Grade A, B and C BL occurred in 3 (10.0 %), 23 (76.6 %) and 4 (13.4 %) cases, respectively. Interventional procedures for BL included endoscopic retrograde cholangiography, percutaneous and surgical drainage in 10 (33.3 %), 23 (76.7 %) and 4 (13.3 %) patients, respectively. BL was associated with significantly increased rates of symptomatic pleural effusion (30.0 vs. 11.4 %, p = 0.006), multiorgan failure (13.3 vs. 3.6 %, p = 0.022), postoperative death (10.0 vs. 1.6 %, p = 0.008) and prolonged hospital stay (18 vs. 8 days, p < 0.001). On multivariable analysis, BMI > 28 kg/m(2) (OR 2.439, 95 % CI 1.878-2.771, p = 0.036), history of hepatectomy (OR 1.675, 95 % CI 1.256-2.035, p = 0.044) and biliary reconstruction (OR 1.975, 95 % CI 1.452-2.371, p = 0.039) were significantly associated with increased risk of BL.
  
  
  
  After LMH, BL occurred in 13.5 % of the patients and was associated with significant morbidity. Patients with one or several risk factors for BL should benefit intra-operative drain placement.
authors.affiliation: Department of HPB Surgery and Liver Transplantation - Hôpital Saint Antoine, University Pierre et Marie Curie Paris 6, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.|Department of HPB Surgery and Liver Transplantation - Hôpital Beaujon, University Denis Diderot Paris 7, 100 Boulevard Général Leclerc, 92118, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. davidfuks80@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of HPB Surgery and Liver Transplantation - Hôpital Saint Antoine, University Pierre et Marie Curie Paris 6, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.affiliation: Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Ajay
authors.initials: A
authors.lastname: Belgaumkar
authors.affiliation: Department of HPB Surgery and Liver Transplantation - Hôpital Saint Antoine, University Pierre et Marie Curie Paris 6, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.|Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Pierre et Marie Curie Paris 6, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Department of HPB Surgery and Liver Transplantation - Hôpital Saint Antoine, University Pierre et Marie Curie Paris 6, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.|Department of HPB Surgery and Liver Transplantation - Hôpital Beaujon, University Denis Diderot Paris 7, 100 Boulevard Général Leclerc, 92118, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000209:etiology; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Abdominal drainage; Bile leakage; Laparoscopic major hepatectomy; Postoperative complications