Jan Bednarsch1,2, Elisabeth Blüthner1, Maciej Malinowski1,3, Daniel Seehofer1, Johann Pratschke1, Martin Stockmann4. 1. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. 2. Department of General, Visceral and Transplantation Surgery, University Clinic Aachen, Rhine Westphalia Institute of Technology, Aachen, Germany. 3. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg, Germany. 4. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. martin.stockmann@charite.de.
Abstract
BACKGROUND: Postoperative bile leakage (PBL) is a major surgical complication after partial liver resection resulting in increased perioperative morbidity and mortality. Previous experimental studies have shown an adverse effect on functional liver regeneration, but there are still no data available concerning these effects in humans. MATERIALS AND METHODS: A retrospective matched pair analysis was carried out comparing the postoperative course of 51 patients with PBL to 51 patients without PBL. The influence of PBL on actual liver function was determined by means of LiMAx, Indocyanine green plasma disappearance rate (ICG-PDR), and standard liver function tests. RESULTS: The analyzed groups were matched regarding demographic, preoperative, and operative data. Bilirubin, ICG-PDR and LiMAx showed delayed postoperative functional recovery after partial liver resection in the PBL group compared to the non-PBL group. LiMAx was the single parameter to assess differing liver regeneration continuously from the 3rd to 14th postoperative day between the groups. A subanalysis revealed an early recovery from impaired functional regeneration if the bile leakage was diagnosed until the 5th postoperative day (POD) or successfully treated until the 14th POD. CONCLUSION: These are the first data evaluating the impact of PBL on functional regeneration after liver surgery. Liver regeneration after partial liver resection is impaired by PBL. However, a nearly normal recovery is possible if the bile leak is diagnosed early and immediately treated. Moreover, patients presenting with delayed functional recovery in the postoperative course are likely to have complications, e.g., bile leakage.
BACKGROUND: Postoperative bile leakage (PBL) is a major surgical complication after partial liver resection resulting in increased perioperative morbidity and mortality. Previous experimental studies have shown an adverse effect on functional liver regeneration, but there are still no data available concerning these effects in humans. MATERIALS AND METHODS: A retrospective matched pair analysis was carried out comparing the postoperative course of 51 patients with PBL to 51 patients without PBL. The influence of PBL on actual liver function was determined by means of LiMAx, Indocyanine green plasma disappearance rate (ICG-PDR), and standard liver function tests. RESULTS: The analyzed groups were matched regarding demographic, preoperative, and operative data. Bilirubin, ICG-PDR and LiMAx showed delayed postoperative functional recovery after partial liver resection in the PBL group compared to the non-PBL group. LiMAx was the single parameter to assess differing liver regeneration continuously from the 3rd to 14th postoperative day between the groups. A subanalysis revealed an early recovery from impaired functional regeneration if the bile leakage was diagnosed until the 5th postoperative day (POD) or successfully treated until the 14th POD. CONCLUSION: These are the first data evaluating the impact of PBL on functional regeneration after liver surgery. Liver regeneration after partial liver resection is impaired by PBL. However, a nearly normal recovery is possible if the bile leak is diagnosed early and immediately treated. Moreover, patients presenting with delayed functional recovery in the postoperative course are likely to have complications, e.g., bile leakage.
Authors: R Otao; T Beppu; T Isiko; K Mima; H Okabe; H Hayashi; T Masuda; A Chikamoto; H Takamori; H Baba Journal: Br J Surg Date: 2012-11 Impact factor: 6.939
Authors: Sander Dinant; Michael F Gerhards; E A J Rauws; Olivier R C Busch; Dirk J Gouma; Thomas M van Gulik Journal: Ann Surg Oncol Date: 2006-04-14 Impact factor: 5.344
Authors: M Stockmann; F W R Vondran; R Fahrner; H M Tautenhahn; J Mittler; H Bektas; M Malinowski; M Jara; I Klein; J F Lock Journal: BJS Open Date: 2018-06-14