title: Biliary fistula after liver resection: central role of intraoperative perihepatic drain.
abstract: BACKGROUNDː Despite notable advances in surgical skills and technology, incidence of biliary fistula after hepatic resection remains an issue. Aim of this study was to assess the role of intraoperative perihepatic drain in diagnosis and treatment of this complication. METHODSː The study included 641 patients who underwent hepatic resection without hepaticojejunostomy between Jan-2003 and Jan-2016. Data were obtained from our single-institution perspective database. RESULTSː Biliary fistula occurred in 3.4% (22/641). Major hepatic resection (P<0.001), S4-involving resection (P=0.006), cholangiocarcinoma (P<0.001) and intraoperative blood losses >375 mL (P<0.001) were associated with biliary fistula. At multivariate analysis, among patients with effective intraoperative perihepatic drain ("D" group) (16/22) onset of biliary fistula (mean, 5.1 vs. 31.5 days, P=0.12) and healing time (mean, 26.5 vs. 82.3 days, P=0.033) were more favorable compared with biloma group (B). Moreover, conservative treatment was more effective in D group (75% of cases). B group developed increased morbidity in terms of jaundice (83.3% vs. 18.7%, P=0.005), abscess (66.7% vs. 6.2%, P=0.003) and a trend of prolonged hospital stay (mean, 25.7 vs. 19.2 days, P=0.51) and mortality (16.7% vs. 6.2%, P=0.449). Difference in biliary fistula severity rate according to ISGLS classification between the two groups was statistically significant (P=0.003). CONCLUSIONSː This study confirms that the wider is the resection the higher the risk for biliary fistula. A correct drainage of bile leakage is the crucial requisite for early healing, providing a milder postoperative course. In our experience, intraoperative perihepatic drain positioning plays a key-role, as well as postoperative patency monitoring.
authors: Hepatic Biliary Pancreatic Surgery and Digestive Unit, Department of General Surgery, Santi Paolo e Carlo Hospital, Milan, Italy - matteo.barabino@asst-santipaolocarlo.it.
authors: Matteo
authors: M
authors: Barabino
authors: Andrea
authors: A
authors: Gatti
authors: Roberto
authors: R
authors: Santambrogio
authors: Leonardo
authors: L
authors: Centonze
authors: Matteo
authors: M
authors: Virdis
authors: Maria R
authors: MR
authors: Angiolini
authors: Carmelo
authors: C
authors: Luigiano
authors: Enrico
authors: E
authors: Opocher
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery; D001658:Biliary Fistula / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016063:Blood Loss, Surgical; D018281:Cholangiocarcinoma / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D000072700:Conservative Treatment; D004322:Drainage / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D007565:Jaundice / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008100:Liver Abscess / Q000453:epidemiology / Q000209:etiology; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D012306:Risk