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Risk factors for postoperative bile leakage:a retrospective single-center analysis of 411 hepatectomies

Hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 81-86页

作者： Fabrizio Panaro Lisa Hacina Hassan Bouyabrine Al-Warith Al-Hashmi Astrid Herrero Francis Navarro Department of General and Liver Transplant Surgery Montpellier University HospitalCollege of Medicine

BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy between December 2006 and December 2011 were ret- rospectively analyzed. The severity of bile leakage was graded according to the ISGLS classification. Twenty-eight pre- and postoperative parameters were analyzed. RESULTS： The overall bile leakage incidence was 10.2% （42/411）. The severity of the leakage was classified according to the IS- GLS classification. bile leakage was detected early in case of abdominal drainage （11.4% vs 1.9%, P=0.034）. It prolonged the time of hospitalization （16 vs 9 days, P=0.001）. In all patients, wedge resection was associated with a higher incidence of bile leakage in contrast to anatomical resections （25.6% vs 4.1%, P〈0.0001） regardless of the underlying liver disease. Furthermore, total vascular exclusion increased risk of bile leakage （P=0.008）. CONCLUSIONS： bile leakage as a major issue after hepatic resection is related to the postoperative morbidity and the hospitalization time. It is associated with non-anatomical re- section and a total vascular exclusion.

关键词： liver resection bile leakage wedge total vascular exclusion

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Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

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World Journal of Gastroenterology 2006年第21期12卷 3450-3452页

作者： Tetsuya Shimizu Hiroshi Yoshida Yasuhiro Mamada Nobuhiko Taniai Satoshi Matsumoto Yoshiaki Mizuguchi Shigeki Yokomuro Yasuo Arima Koho Akimaru Takashi Tajiri Graduate School of Medicine Surgery for Organ Function and Biology Regulation Nippon Medical SchoolTokyo113-8603Japan

We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage （RTBD） tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative man- agement, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

关键词： Postoperative complication bile leakage Ethanol ablation

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Risk Factors,Treatment and Impact on Outcomes of bile leakage after Hemihepatectomy

Risk Factors,Treatment and Impact on Outcomes of Bile Leakag...

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2014年微创外科学术年会

作者： Si-Ming Zheng Hong Li Dan-Song Yu Bin Zhang Cai-De Lu Feng Qiu Gen-Cong Li Xin-Hua Zhou Department of General surgery Ningbo Li Huili HospitalMedical School of Ningbo University

Background:The risk factors of bile leakage after hemihepatectomy have not been investigated in ***:A prospectively maintained database review identified all patients undergoing hemihepatectomy between January 1,2009 and November 31,*** patients were divided into two groups:B/C bile leakage group and non-B/C bile leakage group,according to the diagnosis and grading standards of the International Study Group of Liver *** risk factors for bile leakage were predicted and assessments of their impact on patients were ***:Multivariate analysis confirmed hepatolithiasis,previous liver or biliary tract surgery,increased ALT,laparoscopic surgery,hilar bile duct plasty and longer operation times were risk factors in B/C bile leakage(pbile leakage group were higher than that in non-B/C bile leakage group(pbile leakage group required prolonged hospitalization(pbile duct plasty and laparoscopic surgery must be operated more carefully to avoid bile leakage.

关键词： Hepatectomy Complications bile leakage

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Risk Factors,Treatment and Impact on Outcomes of bile leakage after Hemihepatectomy

Risk Factors,Treatment and Impact on Outcomes of Bile Leakag...

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2014年浙江省外科学学术年会

作者： Si-Ming Zheng Hong Li Dan-Song Yu Bin Zhang Cai-De Lu Feng Qiu Gen-Cong Li Xin-Hua Zhou Department of General surgery Ningbo Li Huili HospitalMedical School of Ningbo University

Background:In 2011,the International Study Group of Liver Surgery(ISGLS)proposed a definition forbile *** risk factors of bile leakage after hemihepatectomy have not been investigated in *** design:A prospectively mai... 详细信息

关键词： Hepatectomy Complications bile leakage

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Phlegmonous gastritis after biloma drainage:A case report and review of the literature

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World Journal of Clinical Cases 2022年第33期10卷 12430-12439页

作者： Kai-Chun Yang Hsin-Yu Kuo Jui-Wen Kang Department of Internal Medicine National Cheng Kung University HospitalTainan 704Taiwan

BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infection of the gastric submucosa and is related to septicemia,direct gastric mucosal injury,or the direct influence of infection or inflammation in neighboring ***,we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma *** SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 *** examination showed stable vital signs,icteric sclera,diffuse abdominal tenderness,and muscle *** tests showed hyperbilirubinemia and *** computed tomography(CT)of the abdomen showed a dilated common bile duct and left subphrenic *** subphrenic abscess drainage revealed bilious fluid,and infected biloma was *** abdominal CT for persistent epigastralgia after drainage showed gastric wall ***(EGD)showed an edematous,hyperemic gastric mucosa with poor *** gastric mucosal culture yielded Enterococcus *** was diagnosed based on imaging,EGD findings,and gastric mucosal *** patient recovered successfully with antibiotic *** PG should be considered in patients with intraabdominal infection,especially from infected organs adjacent to the stomach.

关键词： Phlegmonous gastritis Epigastric pain Choledocholithiasis bile leakage Antibiotics Case report

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Iatrogenic bile duct injuries from biliary tract surgery

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 326-329页

作者： Umar Ali Department of Surgery First Affiliated Hospital School of MedicineXi'an Jiaotong UniversityXi'an 710061China

BACKGROUND:Cholecystectomy is the most commonly performed procedure in general ***,bile duct injury is a rare but still one of the most common *** injuries sometimes present variably after primary *** detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong *** the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was *** patients were followed-up at the surgical outpatient department for six months to three *** far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

关键词： biliary tract surgery iatrogenic bile duct injuries hemorrhage bile leakage

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The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications,preoperative chemotherapy,and surgical procedures

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Hepatobiliary Surgery and Nutrition 2019年第2期8卷 101-110页

作者： Vinzent N.Spetzler Marlene Schepers Hans O.Pinnschmidt Lutz Fischer Bj?rn Nashan Jun Li Department of Hepatobiliary Surgery and Visceral Transplantation University Medical Center Hamburg-EppendorfHamburgGermany Department of Medical Biometry and Epidemiology University Medical Center Hamburg-EppendorfHamburgGermany

Background:bile leaks are one of the most common complications after liver *** International Study Group of Liver Surgery(ISGLS)established a uniform bile leak definition including a severity ***,a risk factor assessment according to ISGLS grading as well as the clinical implications has not been studied sufficiently so ***:The incidence and grading of bile leaks according to ISGLS were prospectively documented in 501 consecutive liver resections between July 2012 and December 2016.A multivariate regression analysis was performed for risk factor *** with other surgical complications,90-day mortality as well as length of hospital stay(LOS)was ***:The total rate of bile leaks in this cohort was 14.0%:2.8%grade A,8.0%grade B,and 3.2%grade C bile leaks were *** chemotherapy or biliary intervention,diagnosis of hilar cholangiocarcinoma,colorectal metastasis,central minor liver resection,major hepatectomy,extended hepatectomy or two-stage hepatectomy,were some of the risk factors leading to bile *** multivariate regression analysis revealed that preoperative chemotherapy,major hepatectomy and biliodigestive reconstruction remained significant independent risk factors for bile *** C bile leaks were associated not only with surgical site infection,but also with an increased 90-day mortality and prolonged ***:The preoperative treatment as well as the surgical procedure had significant influence on the incidence and the severity of bile *** C bile leaks were clinically most relevant,and led to significant increased LOS,rate of infection,and mortality.

关键词： bile leakage post-operative complication liver resection International Study Group of Liver Surgery(ISGLS) Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS)

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Diagnosis and management of cystic duct leakage after laparoscopic cholecystectomy: report of 3 cases

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Hepatobiliary & Pancreatic Diseases International 2005年第1期4卷 147-151页

作者： Ji-Hui Li and Hang-Tao Liu Shanghai, China Minimally Invasive Surgery Center, Shanghai Chang- hai Hospital, Second Military Medical University, Shanghai 200433 , China Minimally Invasive Surgery Center Shanghai Changhai Hospital Second Military Medical University Shanghai 200433 China. jihuilimd@***

BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to eva- luate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symp- toms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiog- raphy and/or endoscopic retrograde cholangiopancreatog- raphy. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperarion for closure of the opened CD stump can be fulfilled under laparosco- py. Endoscopic drainage must be accompanied with effec- tive abdominal drainage.

关键词： cystic duct leakage bile leakage cholecystectomy laparoscopy

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