Masaki Kaibori1, Junzo Shimizu2, Michihiro Hayashi3, Takuya Nakai4, Morihiko Ishizaki5, Kosuke Matsui5, Yong Kook Kim2, Fumitoshi Hirokawa3, Yasuyuki Nakata4, Takehiro Noda6, Keizo Dono6, Akinori Nozawa7, Masanori Kwon5, Kazuhisa Uchiyama3, Shoji Kubo7. 1. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. Electronic address: kaibori@hirakata.kmu.ac.jp. 2. Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan. 3. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan. 4. Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan. 5. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 6. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan. 7. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Abstract
BACKGROUND: Postoperative bile leakage can be a serious complication after hepatic resection. Few studies have analyzed patients according to the time of onset of bile leakage. We analyzed differences between patients with early- and late-onset bile leakage after hepatic resection and assessed clinical characteristics and outcomes in patients with late-onset leakage. METHODS: Between 2008 and 2010, 1,009 patients underwent hepatic resection at 4 participating university hospitals and 2 community hospitals. Fifty-two patients (5.1%) with postoperative bile leakage were divided into an early-onset group (<2 weeks after surgery, n = 34) and a late-onset group (≥2 weeks after surgery, n = 18). Patient characteristics and outcomes were collected prospectively and analyzed retrospectively. RESULTS: The proportion of patients who underwent intra-abdominal placement of a drainage catheter was significantly less in the late-onset group than the early-onset group. All 18 patients in the late-onset group developed intra-abdominal infection, and 2 died of sepsis. The proportion of patients who underwent invasive treatment (abdominal paracentesis, endoscopic biliary drainage, or second hepatic resection) was significantly greater in the late-onset group than in the early-onset group. The time to resolution of bile leakage was significantly greater in the late-onset group than the early-onset group. CONCLUSION: Patients should be monitored carefully for bile leakage for several weeks after hepatic resection, because late-onset bile leakage can cause serious complications. Intra-abdominal infection should also be treated as soon as possible, because it may induce refractory bile leakage with serious complications.
BACKGROUND: Postoperative bile leakage can be a serious complication after hepatic resection. Few studies have analyzed patients according to the time of onset of bile leakage. We analyzed differences between patients with early- and late-onset bile leakage after hepatic resection and assessed clinical characteristics and outcomes in patients with late-onset leakage. METHODS: Between 2008 and 2010, 1,009 patients underwent hepatic resection at 4 participating university hospitals and 2 community hospitals. Fifty-two patients (5.1%) with postoperative bile leakage were divided into an early-onset group (<2 weeks after surgery, n = 34) and a late-onset group (≥2 weeks after surgery, n = 18). Patient characteristics and outcomes were collected prospectively and analyzed retrospectively. RESULTS: The proportion of patients who underwent intra-abdominal placement of a drainage catheter was significantly less in the late-onset group than the early-onset group. All 18 patients in the late-onset group developed intra-abdominal infection, and 2 died of sepsis. The proportion of patients who underwent invasive treatment (abdominal paracentesis, endoscopic biliary drainage, or second hepatic resection) was significantly greater in the late-onset group than in the early-onset group. The time to resolution of bile leakage was significantly greater in the late-onset group than the early-onset group. CONCLUSION:Patients should be monitored carefully for bile leakage for several weeks after hepatic resection, because late-onset bile leakage can cause serious complications. Intra-abdominal infection should also be treated as soon as possible, because it may induce refractory bile leakage with serious complications.