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Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy
Author(s) -
Zheng SiMing,
Li Hong,
Li GenCong,
Yu DanSong,
Ying DongJian,
Zhang Bin,
Lu CaiDe,
Zhou XinHua
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13073
Subject(s) - leakage (economics) , medicine , surgery , economics , macroeconomics
Background Risk factors for bile leakage after hemihepatectomy are unknown. Methods A prospectively maintained database review identified patients undergoing hemihepatectomy between 1 J anuary 2009 and 30 S eptember 2014. Patients were divided into B / C and non‐ B / C bile leakage groups. Risk factors for bile leakage were predicted and assessments of their impact on patients were made. Results Bile leakage occurred in 91 of the 297 patients (30.6%); 64 cases were classified as grade B bile leakage (21.5%) and three cases as grade C bile leakage (1.0%). Multivariate analysis confirmed that elevated preoperative alanine transaminase ( ALT ), positive bile culture during surgery, hilar bile duct plasty, bilioenteric anastomosis and laparoscopic surgery were risk factors for B / C grade bile leakage ( P < 0.05). Percutaneous transhepatic biliary drainage ( PTBD ) and endoscopic nasobiliary drainage ( ENBD ) were protective factors for B / C grade bile leakage ( P < 0.05). PTBD , ENBD and K ehr's T ‐tube drainage could reduce the drainage volume and duration of drainage after bile leakage ( P < 0.05). The incidence of wound infection, abdominal infection, major complications and the C lavien classification system score in the B / C bile leakage group were higher than those in the non‐ B / C bile leakage group ( P < 0.05). Patients in the B / C bile leakage group also required prolonged hospitalization ( P < 0.05). The mortality of two groups was similar ( P > 0.05). Conclusion Patient with elevated preoperative ALT , positive bile cultures during surgery, hilar bile duct plasty, bilioenteric anastomosis and laparoscopic surgery are more likely to complicate bile leakage. We should use biliary drainage such as preoperative PTBD , ENBD or intraoperative K ehr's T ‐tube drainage to reduce and treat bile leakage in patients with high risk of bile leakage.