Bile leakage after hepatic resection

Objective To identify the perioperative risk factors for postoperative bile leakage a fter hepatic resection, to evaluate the intraoperative bile leakage test as a preventive measure, and to propose a treatment strategy for postoperativ e bile leakage according to the outcome of these patients. Summary Background Data Bile leakage remains a common cause of major complications after hepatic re section. Methods Between January 1985 and June 1999, 781 hepatic resections without bilioent eric anastomosis were performed at the authors' institution. Perioperative risk factors related to post operative bile leakage were identified using u nivariate and multivariate analysis. The characteristics of patients with i ntractable bile leakage and the effect of intraoperative bile leakage test were also examined. Management was evaluated in relation to the outcomes an d the clinical characteristics of the patients with bile leakage. Results Bile leakage developed in 31 (4.0%) of 781 hepatic resections. This complic ation carried high risks for surgical death (two patients [6.5%] died). The stepwise logistic regression analysis identified high-risk surgical proced ure, in which the cut surface exposed the major Glisson's sheath and includ ed the hepatic hilum (i.e., anterior segmentectomy, central bisegmentectomy , or total caudate lobectomy), as the independent predictor of the developm ent of postoperative bile leakage. None of the 102 cases in which an intrao perative bile leakage test was performed were subsequently complicated by p ostoperative bile leakage, and the preventive effect of the test was statis tically significant. Patients with fisterographically demonstrable leakage from the hepatic hilum and with postoperative uncontrollable ascites had po or outcomes. Conclusion Patients with bile leakage from the hepatic hilum and postoperative uncontr ollable ascites tend to have a poor prognosis. Therefore, especially when a high-risk surgical procedure is performed in patients with liver cirrhosis , more careful surgical procedures and use of an intraoperative bile leakag e test are recommended.