François Cauchy1,2, David Fuks3, Takeo Nomi4, Lilian Schwarz1, Ajay Belgaumkar4, Olivier Scatton1,5, Olivier Soubrane1,2, Brice Gayet4. 1. Department of HPB Surgery and Liver Transplantation - Hôpital Saint Antoine, University Pierre et Marie Curie Paris 6, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France. 2. Department of HPB Surgery and Liver Transplantation - Hôpital Beaujon, University Denis Diderot Paris 7, 100 Boulevard Général Leclerc, 92118, Clichy, France. 3. Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. davidfuks80@gmail.com. 4. Department of Digestive Disease - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. 5. Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Pierre et Marie Curie Paris 6, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Abstract
BACKGROUND: Bile leakage (BL) remains a common cause of major morbidity after open major liver resection but has only been poorly described in patients undergoing laparoscopic major hepatectomy (LMH). The present study aimed to determine the incidence, risk factors and consequences of BL following LMH. METHODS: All 223 patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were retrospectively analysed. BL was defined according to the International Study Group of Liver Surgery, and its incidence and consequences were assessed. Risk factors for BL were determined on multivariate analysis. RESULTS: BL occurred in 30 (13.5 %) patients, and its incidence remained stable over time (p = 0.200). BL was diagnosed following the presence of bile into the abdominal drain in 14 (46.7 %) patients and after drainage of symptomatic abdominal collections in 16 (53.3 %) patients without intra-operative drain placement. Grade A, B and C BL occurred in 3 (10.0 %), 23 (76.6 %) and 4 (13.4 %) cases, respectively. Interventional procedures for BL included endoscopic retrograde cholangiography, percutaneous and surgical drainage in 10 (33.3 %), 23 (76.7 %) and 4 (13.3 %) patients, respectively. BL was associated with significantly increased rates of symptomatic pleural effusion (30.0 vs. 11.4 %, p = 0.006), multiorgan failure (13.3 vs. 3.6 %, p = 0.022), postoperative death (10.0 vs. 1.6 %, p = 0.008) and prolonged hospital stay (18 vs. 8 days, p < 0.001). On multivariable analysis, BMI > 28 kg/m(2) (OR 2.439, 95 % CI 1.878-2.771, p = 0.036), history of hepatectomy (OR 1.675, 95 % CI 1.256-2.035, p = 0.044) and biliary reconstruction (OR 1.975, 95 % CI 1.452-2.371, p = 0.039) were significantly associated with increased risk of BL. CONCLUSIONS AND RELEVANCE: After LMH, BL occurred in 13.5 % of the patients and was associated with significant morbidity. Patients with one or several risk factors for BL should benefit intra-operative drain placement.
BACKGROUND: Bile leakage (BL) remains a common cause of major morbidity after open major liver resection but has only been poorly described in patients undergoing laparoscopic major hepatectomy (LMH). The present study aimed to determine the incidence, risk factors and consequences of BL following LMH. METHODS: All 223 patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were retrospectively analysed. BL was defined according to the International Study Group of Liver Surgery, and its incidence and consequences were assessed. Risk factors for BL were determined on multivariate analysis. RESULTS: BL occurred in 30 (13.5 %) patients, and its incidence remained stable over time (p = 0.200). BL was diagnosed following the presence of bile into the abdominal drain in 14 (46.7 %) patients and after drainage of symptomatic abdominal collections in 16 (53.3 %) patients without intra-operative drain placement. Grade A, B and C BL occurred in 3 (10.0 %), 23 (76.6 %) and 4 (13.4 %) cases, respectively. Interventional procedures for BL included endoscopic retrograde cholangiography, percutaneous and surgical drainage in 10 (33.3 %), 23 (76.7 %) and 4 (13.3 %) patients, respectively. BL was associated with significantly increased rates of symptomatic pleural effusion (30.0 vs. 11.4 %, p = 0.006), multiorgan failure (13.3 vs. 3.6 %, p = 0.022), postoperative death (10.0 vs. 1.6 %, p = 0.008) and prolonged hospital stay (18 vs. 8 days, p < 0.001). On multivariable analysis, BMI > 28 kg/m(2) (OR 2.439, 95 % CI 1.878-2.771, p = 0.036), history of hepatectomy (OR 1.675, 95 % CI 1.256-2.035, p = 0.044) and biliary reconstruction (OR 1.975, 95 % CI 1.452-2.371, p = 0.039) were significantly associated with increased risk of BL. CONCLUSIONS AND RELEVANCE: After LMH, BL occurred in 13.5 % of the patients and was associated with significant morbidity. Patients with one or several risk factors for BL should benefit intra-operative drain placement.
Entities:
Keywords:
Abdominal drainage; Bile leakage; Laparoscopic major hepatectomy; Postoperative complications
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