Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar;15(3):224-9.
doi: 10.1111/j.1477-2574.2012.00580.x. Epub 2012 Oct 4.

Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections

Antoine Guillaud  1 , Claire Pery, Boris Campillo, Anne Lourdais, Laurent Sulpice, Karim Boudjema
Affiliations

Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections

Antoine Guillaud et al. HPB (Oxford). 2013 Mar.

Erratum in

  • HPB (Oxford). 2013 May;15(5):401. Laurent, Sulpice [corrected to Sulpice, Laurent]

Abstract

Objective: To evaluate the incidence, the impact on survival and the predictive factors of bile leakage (BL) in a recent large monocentric series of liver resections performed in a referral tertiary care centre.

Background: Previous reports dealing with bile leakage (BL) after liver resection are rare and have displayed conflicting results regarding incidence, impact on follow-up and predictive factors.

Methods: A retrospective review of the records of 912 patients who underwent a total of 1001 consecutive liver resections without biliary reconstruction, performed between January 2005 and May 2011. BL was defined by the presence of bile in the abdominal drains, a radiologically or surgically drained bilioma or biliary peritonitis. BL severity was established according to the Clavien-Dindo classification. Fifty-eight pre-, per- and post-resection variables were analysed and the independent BL predictive factors were identified using logistic regression.

Results: The incidence of BL was 8%. Clavien-Dindo I-II, IIIa, IIIb or IV rates were 29%, 35%, 32.5% and 2.5%, respectively. BL did not increase in-hospital mortality (2.5% versus 2.9%, P = 1.0), but doubled the median duration of hospital stay (16 versus 9 days, P < 0.001) and increased 1-year mortality (11% versus 5%, P = 0.03). Multivariate analysis identified that pre-operative bevacizumab [odds ratio (OR) = 2.9, confidence interval (CI) 95% = 1.58-5.41] P = 0.001], a major hepatectomy [OR = 2.6 (CI 95% = 1.48-4.76) P = 0.001], a two-stage hepatectomy [OR = 2.5 (CI 95% = 1.17-5.52) P = 0.018], the selective clamping technique [OR = 2.6 (CI 95% = 1.03-6.78) P = 0.042], R1 or R2 resection [OR = 2.6 (CI 95% = 1.52-4.64) P = 0.001] and the absence of a methylene blue test [OR = 2.6 (IC 95% = 1.43-4.65) P = 0.002] were independent risk factors of BL.

Conclusion: BL remains frequent after liver resection. It has a dramatic impact on patient survival and care costs. Its incidence could be reduced by avoiding the pre-operative use of bevacizumab, avoiding selective clamping and performing a blue dye test in all resections.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incidence of bile leakage related to the year of surgery
See this image and copyright information in PMC

Comment in

References

    1. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406. et al; discussion 067. - PMC - PubMed
    1. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708. et al; discussion 0810. - PMC - PubMed
    1. Andersson R, Tranberg KG, Bengmark S. Roles of bile and bacteria in biliary peritonitis. Br J Surg. 1990;77:36–39. - PubMed
    1. Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M. Bile leakage after hepatic resection. Ann Surg. 2001;233:45–50. et al. - PMC - PubMed
    1. Lam CM, Lo CM, Liu CL, Fan ST. Biliary complications during liver resection. World J Surg. 2001;25:1273–1276. - PubMed

MeSH terms