Influence of anti-adhesive agent on incidence of bile leakage after liver resection: A prospective cohort study.
BACKGROUND
Anti-adhesive agents are increasingly used to reduce the incidence of postoperative adhesions following abdominal surgery. Bile leakage after liver resection remains a major cause of postoperative morbidity. The aim of this study was to examine the effect of anti-adhesive agent on bile leakage after liver resection.


METHODS
77 patients were enrolled to receive an anti-adhesive agent (study group) during liver resection between May 2012 and August 2013. The study group was compared to a match-paired control group. Clinical data were collected including bilirubin concentration in serum and drain fluid and bile leakage rate. In addition, a separate analysis was performed between patients with and without postoperative bile leakage.


RESULTS
There was no difference in bile leakage rate or hospital stay between the study group (n = 77) and control group (n = 77). Of the total number of patients (n = 154), there were 29 patients with postoperative bile leak and 125 patients without bile leak. On univariate analysis, patients without history of hepatitis were significantly associated with bile leakage. In addition, liver resection with broader cut surface area was associated with bile leakage. Application of anti-adhesive agent was not associated with bile leakage. On multivariate analysis, resection with broader cut surface area (OR = 2.788, p = 0.026) and patients without history of hepatitis (OR = 5.153, p = 0.039) were significantly associated with bile leakage.


CONCLUSIONS
Larger area of cut-surface and patients without history of hepatitis were significant risk factors for bile leakage. The use of anti-adhesive agent was not associated with increased risk of bile leakage.
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: hust1351@naver.com.
Young-Dong
YD
Yu
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: kimds1@korea.ac.kr.
Dong-Sik
DS
Kim
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: sungwon94@naver.com.
Sung-Won
SW
Jung
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: gelasius1@naver.com.
Jae-Hyun
JH
Han
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: docsuh@chollian.net.
Sung-Ock
SO
Suh
D000287:Administration, Topical; D000464:Alginates / Q000008:administration & dosage*; D057868:Anastomotic Leak / Q000209:etiology*; D001646:Bile; D005260:Female; D020723:Glucuronic Acid / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects*; D006603:Hexuronic Acids / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008099:Liver / Q000187:drug effects / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020442:Poloxamer / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D013501:Surface-Active Agents / Q000008:administration & dosage*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
D000464:Alginates; D006603:Hexuronic Acids; D013501:Surface-Active Agents; D020442:Poloxamer; D020723:Glucuronic Acid
Anti-adhesive agent; Bile leakage; Liver resection