Yujiro Tanaka1,2, Takahisa Tainaka3, Akinari Hinoki3, Chiyoe Shirota3, Wataru Sumida3, Kazuki Yokota3, Kazuo Oshima4,3, Satoshi Makita3, Hizuru Amano5, Aitaro Takimoto3, Yoko Kano3, Hiroo Uchida3. 1. Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma-gun, Saitama, 350-0495, Japan. ytanaka-tky@umin.ac.jp. 2. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. ytanaka-tky@umin.ac.jp. 3. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. 4. Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma-gun, Saitama, 350-0495, Japan. 5. Department of Pediatric Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, 113-8655, Japan.
Abstract
PURPOSE: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. METHODS: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. RESULTS: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. CONCLUSION: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.
PURPOSE: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. METHODS: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. RESULTS: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. CONCLUSION: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.
Entities:
Keywords:
Bile leak; Congenital biliary dilatation; Early complication; Laparoscopic surgery
Authors: Moritz Koch; O James Garden; Robert Padbury; Nuh N Rahbari; Rene Adam; Lorenzo Capussotti; Sheung Tat Fan; Yukihiro Yokoyama; Michael Crawford; Masatoshi Makuuchi; Christopher Christophi; Simon Banting; Mark Brooke-Smith; Val Usatoff; Masato Nagino; Guy Maddern; Thomas J Hugh; Jean-Nicolas Vauthey; Paul Greig; Myrddin Rees; Yuji Nimura; Joan Figueras; Ronald P DeMatteo; Markus W Büchler; Jürgen Weitz Journal: Surgery Date: 2011-02-12 Impact factor: 3.982