T-drain reduces the incidence of biliary leakage after liver resection.
Biliary leakage is a serious complication after liver resection and represents the major cause of post-operative morbidity. In spite of already identified risk factors, little is known about the role of intra-biliary pressure following liver surgery in the development of biliary leakage. Biliary decompression may have a positive impact and reduce the incidence of biliary leakage at the parenchymal resection site. 397 patients undergoing liver resection without bilioenteric anastomosis were included in the retrospective analysis of the risk factors for the development of biliary leakage focusing on the intra-operative reduction of the biliary pressure by T-tube and liver histology. Among 397 analyzed patients after parenchymal resection, biliary leakage occurred in 39 cases (9.8 %). The extent of parenchymal resection was not associated with the total occurrence of biliary leak (p = 0.626). Lower incidence of biliary leakage from the resection surface was significantly associated with the use of T-tube (4.9 vs. 13.2 %; p = 0.006). In the subgroup analysis, insertion of a T-tube was not associated with a reduction of biliary leakage after anatomical hemihepatectomies (p = 0.103) and extraanatomical liver resection (p = 0.676). However, a high statistical significance could be detected in patients with extended hemihepatectomies (58.3 vs. 3.8 %; p < 0.001). Once biliary leak occurred without T-tube, median hospitalization duration significantly increased compared to patients with biliary decompression and without biliary leak (p < 0.001). The results of our retrospective data analysis suggest a significant beneficial impact of the T-tube on the development of biliary leakage in patients undergoing extended liver surgery.
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany. dennis.eurich@charite.de.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. dennis.eurich@charite.de.
Dennis
D
Eurich
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
S
S
Henze
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
S
S
Boas-Knoop
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
J
J
Pratschke
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
D
D
Seehofer
D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
Biliary drainage; Liver resection; Parenchymal biliary leak
Arch Surg. 2006 Jul;141(7):690-4; discussion 695
16847242
World J Surg. 2001 Oct;25(10):1273-6
11596889
J Am Coll Surg. 2002 Oct;195(4):484-9
12375753
Am J Surg. 2003 Apr;185(4):316-8
12657381
Gastrointest Endosc. 2003 Apr;57(4):526-30
12665763
World J Surg. 2004 Aug;28(8):782-6
15457358
World J Surg. 2003 Jun;27(6):695-8
12732991
Arch Surg. 2003 Nov;138(11):1198-206; discussion 1206
14609867
HPB (Oxford). 2015 Jul;17(7):651-8
26058324
Eur Radiol. 1998;8(9):1602-7
9866770
Dig Surg. 2007;24(4):294-9
17657155
Ann Surg. 1993 Aug;218(2):167-75
8342996
Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):380-8
16502179
Arch Surg. 2000 Dec;135(12):1395-400
11115338
Hepatogastroenterology. 2002 Nov-Dec;49(48):1496-8
12397716
Surgery. 1975 Jul;78(1):6-13
1094576
Ann Surg. 2002 Oct;236(4):397-406; discussion 406-7
12368667
Arch Surg. 1998 Feb;133(2):156-61
9484727
Ann Surg. 2001 Jan;233(1):45-50
11141224
J Hepatol. 1996 Nov;25(5):649-54
8938541
J Hepatobiliary Pancreat Surg. 2005;12(5):351-5
16258801
Am J Surg. 2000 Feb;179(2):103-9
10773143
Hepatology. 1994 Jun;19(6):1513-20
8188183
Gastrointest Endosc. 2004 Oct;60(4):567-74
15472680
Ann Surg. 1986 Feb;203(2):148-52
3947153