Archives of surgery (Chicago, Ill. : 1960) · 2006
Bile leakage and liver resection: Where is the risk?
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Capussotti Lorenzo, Ferrero Alessandro, Viganò Luca, Sgotto Enrico, Muratore Andrea, Polastri Roberto
Аннотация
HYPOTHESIS: The knowledge of risk factors for bile leakage after liver resection could reduce its incidence.
DESIGN: Retrospective study.
SETTING: Tertiary care referral center.
PATIENTS: The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.
INTERVENTIONS: Liver resections without biliary anastomoses.
MAIN OUTCOME MEASURES: Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.
RESULTS: Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P < .001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.
CONCLUSIONS: Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.
DESIGN: Retrospective study.
SETTING: Tertiary care referral center.
PATIENTS: The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.
INTERVENTIONS: Liver resections without biliary anastomoses.
MAIN OUTCOME MEASURES: Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.
RESULTS: Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P < .001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.
CONCLUSIONS: Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.