Biliary complications during liver resection

Biliary complications after hepatectomy may lead to sepsis, liver failure, and death. Measures to detect biliary injury after liver transection may re duce such morbidity. The aim of this study was to investigate the trend of biliary complications after hepatectomy during the last 10 years and assess the efficacy of intraoperative measures (methylene blue test, cholangiogra phy, fibrin glue application) for reducing postoperative biliary complicati ons. This is a retrospective study of 616 consecutive patients who underwen t hepatectomy in our institution from January 1989 to September 1998. The s tudy period was divided into the first 5 years and the second 5 years for c omparison. The hospital mortality rate was 6%. It was significantly reduced during the second 5-year period (3.3% vs. 10.6%; p = 0.0002). The postoper ative biliary leakage rate was 5.5% and was also reduced during the second 5-year period (3.5% vs. 9.8%; p = 0.004). Postresection methylene blue test s were performed more frequently during the second 5-year period than the f irst (63% vs. 28%; p = 0.0001). The postoperative biliary leakage rate was reduced by the methylene blue test (3.6% vs. 7.3%; p < 0.05) but not by app lication of fibrin glue (7.2% vs. 4.2%) or postresection cholangiography. H owever, among the 60 patients with a positive methylene blue test, postoper ative biliary leakage still occurred in 10% of them after the leakage sites were sutured. In conclusion, the biliary complication rate is decreasing. Only the postresection methylene blue test, but not postresection cholangio graphy or application of fibrin glue, helps to reduce the postoperative bil iary leakage rate.