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Review
. 2024 Sep 13:9:70.
doi: 10.21037/tgh-24-9. eCollection 2024.

Hepatobiliary anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks

Olivia Rennie  1   2 , Manaswi Sharma  1 , Nour Helwa  1
Affiliations
Review

Hepatobiliary anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks

Olivia Rennie et al. Transl Gastroenterol Hepatol. .

Abstract

Background and objective: Hepatobiliary diseases are a longstanding and significant medical challenge which, despite advances in surgical techniques, still carry risks for postoperative complications such as anastomotic leaks (ALs), which can include both postoperative pancreatic fistula (POPF) and bile leaks (BL). These complications incur significant human and economic costs on all those involved, including the patient, healthcare providers, and hospital systems. The aim of this study was to construct a narrative review of literature surrounding definitions and grading systems for ALs in the context of hepato-pancreato-biliary (HPB) procedures, and consequences of POPF and BL.

Methods: A literature review was conducted by examining databases including PubMed, Web of Science, OVID Embase, Google Scholar, and Cochrane library databases. Searches were performed with the following search criteria: (((((((anastomosis) OR (anastomotic leak*)) OR (postoperative pancreatic fistula)) OR (bile leak*)) OR (pancreaticoduodenectomy)) OR (whipple)) AND ((hepatobiliary) OR (hepato-pancreato-biliary)) AND ((definition) OR (grading system*) OR (consequences) OR (outcomes) OR (risk factor*) OR (morbidity) OR (mortality))). Publications that were retrieved underwent further assessment to ensure other relevant publications were identified and included.

Key content and findings: A universally accepted definition and grading system for POPF and BL continues to be lacking, leading to variability in reported incidence in the literature. Various groups have worked to publish guidelines for defining and grading POPF and BL, with the International Study Group in Pancreatic Surgery (ISGPS) and International Study Group for Liver Surgery (ISGLS) definitions the current most recommended definitions for POPF and BL, respectively. The burden of AL on patients, healthcare providers, and hospitals is well documented in evidence from leak consequences, such as increased morbidity and mortality, higher reoperation rates, and increased readmission rates, among others.

Conclusions: AL remains a significant challenge in HPB surgery, despite medical advancements. Understanding the progress made in defining and grading leaks, as well as the range of negative outcomes that arise from AL, is crucial in improving patient care, reduce surgical mortality, and drive further advancements in earlier detection and treatment of AL.

Keywords: Anastomotic leak (AL); bile leak (BL); grading systems; hepato-pancreato-biliary (HPB); postoperative pancreatic fistula (POPF).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-24-9/coif). O.R. is a full-time permanent employee of FluidAI Medical, a medical device company that works on early prediction of postoperative complications, including anastomotic leaks. The company contributes to research associated with this manuscript in the following ways: clinical interest in the topic of this manuscript; attendance at conferences/educational events related to this article’s content, travel related to this article’s content, and stock options with the company. M.S. is a full-time permanent employee of FluidAI Medical, a medical device company that works on early prediction of postoperative complications, including anastomotic leaks. The author holds clinical interest and professional expertise in the topics explored within this article. The author also attends meetings/travel related to content in this article through their role at FluidAI Medical, and owns stock options with the company. N.H. is a full-time employee at FluidAI Medical which focuses on the early predication of leaks after gastrointestinal surgery. The author’s role at FluidAI involves expertise in the topics explored within this article. The author also holds stock options with FluidAI. The authors have no other conflicts of interest to declare.

References

    1. Spirou Y, Petrou A, Christoforides C, et al. History of biliary surgery. World J Surg 2013;37:1006-12. 10.1007/s00268-013-2060-3 - DOI - PubMed
    1. Diamantis T, Tsigris C, Kiriakopoulos A, et al. Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11-year experience in one institute. Surg Today 2005;35:841-5. 10.1007/s00595-005-3038-z - DOI - PubMed
    1. Karamanos E, editor. Common Surgeries Made Easy: A Quick Guide for Residents and Medical Students. Cham: Springer International Publishing; 2020 [cited 2023 Aug 5].
    1. Egeli T, Unek T, Ozbilgin M, et al. A Novel Technique for Managing Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy. Case Rep Surg 2016;2016:5392923. 10.1155/2016/5392923 - DOI - PMC - PubMed
    1. Crippa S, Salvia R, Falconi M, et al. Anastomotic leakage in pancreatic surgery - HPB. [cited 2022 Aug 12]. Available from: https://www.hpbonline.org/article/S1365-182X(15)31006-6/fulltext - PMC - PubMed