Risk Factors and Managements of Bile Leakage After Hepatectomy

Abstract

Background: The purpose of this study was to retrospectively determine the risk factors and evaluate the management of bile leakage.

Methods: Three hundred and thirty-four patients who underwent hepatectomy for Child classification grade A liver disease, without biliary reconstruction and laparoscopic procedures, between 2003 and 2013 were included. Risk factors were identified using multivariate analysis.

Results: Bile leakage was observed in 30 (9.0%) patients. Multivariate analysis demonstrated that type of hepatectomy (segmentectomy 1, medial sectionectomy, anterior sectionectomy, or central bisectionectomy) and operating time was independent risk factors for bile leakage. Among 30 patients with confirmed bile leakage, central type leakage that was in communication with the biliary tree occurred in 23 (76.7%) patients and peripheral type, which was not in communication with the biliary tree, in 7 (23.3%) patients. Ten patients were treated with only drainage. Endoscopic or percutaneous transhepatic procedures were performed in 15 cases with central type leakage. Ablation treatment using ethanol or minocycline was mainly performed for peripheral type leakage. Four cases with central type leakage had strictures of the right hepatic duct. Two of them were treated with ablation treatment, portal vein embolization, or fistulojejunostomy. Median duration from diagnosis to end of therapy was 77 days (11-323) in central type and 44 days (6-123) in peripheral type leakage, respectively.

Conclusions: Complex hepatectomy and operating time are independent risk factors for postoperative bile leakage. Biliary exploration should be performed as soon as possible after diagnosis, because most bile leakage is the central type. Central type of bile leakage is sometimes refractory to therapy, needing various treatments and requiring a long time for recovery.

Fig. 1

Receiver operating characteristic curve analysis for operating time and blood loss

Fig. 2

Among patients with central type bile leakage, seven of them were successfully treated by only drainage (one patient died during drainage). After drainage, endoscopic or percutaneous transhepatic procedures were performed in 15 patients, 12 of whom were cured (one patient died during treatment). In two patients who were difficult to cure by this treatment, ablation treatment, portal vein embolization, or fistulojejunostomy were performed. Two patients with peripheral type bile leakage were cured by drainage alone. After drainage, ethanol or minocycline ablation was performed in five patients, the procedure being successful in all of them. “Cure” is defined as the time until drainage tube is completely removed