Diagnosis and Management of Bile Leaks After Hepatectomy: Results of a Prospective Analysis of 475 Hepatectomies

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Abstract

BACKGROUND: The diagnosis and management of bile leaks after hepatectomy are heterogeneous because there is no agreement on the definition of post-hepatectomy biliary fistula. The aim of this study was to validate our definition and management of biliary fistulas after hepatic resection and to compare our results with those proposed by other authors.

METHODS: A prospective series of patients who underwent hepatic resection from 2004 to 2012 were established. Drains were maintained for 7 days, and bilirubin was measured on postoperative days (PODs) 3, 5, and 7. Drains were removed if the bilirubin on POD 7 was less than that on POD 5 and less than 171 µmol/l (10 mg/dl). A statistical analysis of prognostic factors for biliary fistula was performed.

RESULTS: Among 475 consecutive patients, 39 (8%) had biliary fistulas. Only 8 (1.7%) patients required postoperative interventions. In comparison with other studies, we observed a higher rate of bile leaks, but at the same time, we observed a lower rate of interventional procedures. The area under the receiver operating characteristic curve on POD 7 had the highest predictive value (0.81; P <0.001). Pringle maneuvers lasting ≥90 min (OR = 3.4; P <0.001), extended resections (OR = 6.4; P = 0.007), blood transfusions (OR = 2.4; P = 0.035), and resections including segment I (OR = 1.9; P = 0.033) or segment V (OR = 1.8; P = 0.024) were independently associated with an increased risk of bile leak.

CONCLUSIONS: The proposed definition of biliary fistula provides effective recognition of those that are clinically relevant with a reduction of the risk of unrecognized collections and minimal postoperative morbidity.

REGISTRATION NUMBER: NCT02056028 ( http://www.clinicaltrials.gov ).

Original languageEnglish
Pages (from-to)172-181
Number of pages10
JournalWorld Journal of Surgery
Volume40
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Biliary Fistula
Hepatectomy
Bile
Bilirubin
Liver
Risk Reduction Behavior
ROC Curve
Blood Transfusion
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{b22ec4d1ee024ccbb0a504e7a1237e3f,
title = "Diagnosis and Management of Bile Leaks After Hepatectomy: Results of a Prospective Analysis of 475 Hepatectomies",
abstract = "BACKGROUND: The diagnosis and management of bile leaks after hepatectomy are heterogeneous because there is no agreement on the definition of post-hepatectomy biliary fistula. The aim of this study was to validate our definition and management of biliary fistulas after hepatic resection and to compare our results with those proposed by other authors.METHODS: A prospective series of patients who underwent hepatic resection from 2004 to 2012 were established. Drains were maintained for 7 days, and bilirubin was measured on postoperative days (PODs) 3, 5, and 7. Drains were removed if the bilirubin on POD 7 was less than that on POD 5 and less than 171 µmol/l (10 mg/dl). A statistical analysis of prognostic factors for biliary fistula was performed.RESULTS: Among 475 consecutive patients, 39 (8{\%}) had biliary fistulas. Only 8 (1.7{\%}) patients required postoperative interventions. In comparison with other studies, we observed a higher rate of bile leaks, but at the same time, we observed a lower rate of interventional procedures. The area under the receiver operating characteristic curve on POD 7 had the highest predictive value (0.81; P <0.001). Pringle maneuvers lasting ≥90 min (OR = 3.4; P <0.001), extended resections (OR = 6.4; P = 0.007), blood transfusions (OR = 2.4; P = 0.035), and resections including segment I (OR = 1.9; P = 0.033) or segment V (OR = 1.8; P = 0.024) were independently associated with an increased risk of bile leak.CONCLUSIONS: The proposed definition of biliary fistula provides effective recognition of those that are clinically relevant with a reduction of the risk of unrecognized collections and minimal postoperative morbidity.REGISTRATION NUMBER: NCT02056028 ( http://www.clinicaltrials.gov ).",
author = "Matteo Donadon and Guido Costa and Matteo Cimino and Fabio Procopio and {Del Fabbro}, Daniele and Angela Palmisano and Guido Torzilli",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/s00268-015-3143-0",
language = "English",
volume = "40",
pages = "172--181",
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T1 - Diagnosis and Management of Bile Leaks After Hepatectomy

T2 - Results of a Prospective Analysis of 475 Hepatectomies

AU - Donadon, Matteo

AU - Costa, Guido

AU - Cimino, Matteo

AU - Procopio, Fabio

AU - Del Fabbro, Daniele

AU - Palmisano, Angela

AU - Torzilli, Guido

PY - 2016/1/1

Y1 - 2016/1/1

N2 - BACKGROUND: The diagnosis and management of bile leaks after hepatectomy are heterogeneous because there is no agreement on the definition of post-hepatectomy biliary fistula. The aim of this study was to validate our definition and management of biliary fistulas after hepatic resection and to compare our results with those proposed by other authors.METHODS: A prospective series of patients who underwent hepatic resection from 2004 to 2012 were established. Drains were maintained for 7 days, and bilirubin was measured on postoperative days (PODs) 3, 5, and 7. Drains were removed if the bilirubin on POD 7 was less than that on POD 5 and less than 171 µmol/l (10 mg/dl). A statistical analysis of prognostic factors for biliary fistula was performed.RESULTS: Among 475 consecutive patients, 39 (8%) had biliary fistulas. Only 8 (1.7%) patients required postoperative interventions. In comparison with other studies, we observed a higher rate of bile leaks, but at the same time, we observed a lower rate of interventional procedures. The area under the receiver operating characteristic curve on POD 7 had the highest predictive value (0.81; P <0.001). Pringle maneuvers lasting ≥90 min (OR = 3.4; P <0.001), extended resections (OR = 6.4; P = 0.007), blood transfusions (OR = 2.4; P = 0.035), and resections including segment I (OR = 1.9; P = 0.033) or segment V (OR = 1.8; P = 0.024) were independently associated with an increased risk of bile leak.CONCLUSIONS: The proposed definition of biliary fistula provides effective recognition of those that are clinically relevant with a reduction of the risk of unrecognized collections and minimal postoperative morbidity.REGISTRATION NUMBER: NCT02056028 ( http://www.clinicaltrials.gov ).

AB - BACKGROUND: The diagnosis and management of bile leaks after hepatectomy are heterogeneous because there is no agreement on the definition of post-hepatectomy biliary fistula. The aim of this study was to validate our definition and management of biliary fistulas after hepatic resection and to compare our results with those proposed by other authors.METHODS: A prospective series of patients who underwent hepatic resection from 2004 to 2012 were established. Drains were maintained for 7 days, and bilirubin was measured on postoperative days (PODs) 3, 5, and 7. Drains were removed if the bilirubin on POD 7 was less than that on POD 5 and less than 171 µmol/l (10 mg/dl). A statistical analysis of prognostic factors for biliary fistula was performed.RESULTS: Among 475 consecutive patients, 39 (8%) had biliary fistulas. Only 8 (1.7%) patients required postoperative interventions. In comparison with other studies, we observed a higher rate of bile leaks, but at the same time, we observed a lower rate of interventional procedures. The area under the receiver operating characteristic curve on POD 7 had the highest predictive value (0.81; P <0.001). Pringle maneuvers lasting ≥90 min (OR = 3.4; P <0.001), extended resections (OR = 6.4; P = 0.007), blood transfusions (OR = 2.4; P = 0.035), and resections including segment I (OR = 1.9; P = 0.033) or segment V (OR = 1.8; P = 0.024) were independently associated with an increased risk of bile leak.CONCLUSIONS: The proposed definition of biliary fistula provides effective recognition of those that are clinically relevant with a reduction of the risk of unrecognized collections and minimal postoperative morbidity.REGISTRATION NUMBER: NCT02056028 ( http://www.clinicaltrials.gov ).

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U2 - 10.1007/s00268-015-3143-0

DO - 10.1007/s00268-015-3143-0

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