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Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer

World Journal of Gastrointestinal Surgery 2024年第1期16卷 67-75页

作者： Gang Wu Wen-Ying Li Yu-Xing Gong Feng Lin Chen Sun General Surgery Department The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150000Heilongjiang ProvinceChina

BACKGROUND bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.

关键词： Open hepatectomy bile leak Biliary tract cancer Risk factors Management Complication

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Pedicled greater omentum flap for preventing bile leak in liver transplantation patients with poor biliary tract conditions

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 470-473页

作者： Ye, Qi-Fa Niu, Ying She, Xing-Guo Ming, Ying-Zi Cheng, Ke Ma, Yin Ren, Zu-Hai Cent S Univ Xiangya Hosp 3 Res Ctr Natl Hlth Minist Transplantat Med Engn & Technol Changsha 410013 Peoples R China

BACKGROUND: bile leak remains a main complication in liver transplantation patients with poor biliary tract conditions, mainly caused by an insufficient blood supply or dysplasia of the biliary tract. Although Roux-en-Y modus operandi can be adopted, the risk of other complications of the biliary tract such as infection increases. Using pedicled greater omentum flaps to wrap the anastomotic stoma, which increases the biliary tract blood supply, may reduce the incidence of bile leak. METHODS: Fourteen patients undergoing piggy-back liver transplantation and having poor biliary tract conditions were treated with pedicled greater omentum flaps to wrap the anastomotic stoma of the biliary tract. Their clinical data were analyzed retrospectively. RESULTS: Of the 14 patients, only one (7.1%) had a mild bile leak on the 8th day post-operation and fully recovered after symptomatic treatment. The other patients had no biliary complications. CONCLUSIONS: Using pedicled greater omentum flaps to wrap the anastomotic stoma of the biliary tract is an effective way to prevent bile leak in liver transplantation patients, especially those with poor biliary tract conditions. However, experience with this surgical technique still needs to be further explored.

关键词： liver transplantation bile leak greater omentum flap

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bile leakage after loop closure vs clip closure of the cystic duct during laparoscopic cholecystectomy:A retrospective analysis of a prospective cohort

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World Journal of Gastrointestinal Surgery 2020年第1期12卷 9-16页

作者： Sandra C Donkervoort Lea M Dijksman Aafke H van Dijk Emile A Clous Marja A Boermeester Bert van Ramshorst Djamila Boerma Department of Surgery Onze Lieve Vrouwe GasthuisAmsterdam 1090 HMNetherlands Department of Research and Epidemiology St.Antonius HospitalNieuwegein 3435 CMNetherlands Department of Surgery Academic Medical CentreAmsterdam 1105 AZNetherlands

BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most frequently performed surgical procedures.Cystic stump leakage is an underestimated,potentially life threatening complication that occurs in 1%-6%of the patients.With a secure cystic duct occlusion technique during LC,bile leakage becomes a preventable complication.AIM To investigate the effect of polydioxanone(PDS)loop closure of the cystic duct on bile leakage rate in LC patients.METHODS In this retrospective analysis of a prospective cohort,the effect of PDS loop closure of the cystic duct on bile leakage complication was compared to patients with conventional clip closure.Logistic regression analysis was used to develop a risk score to identify bile leakage risk.leakage rate was assessed for categories of patients with increasing levels of bile leakage risk.RESULTS Of the 4359 patients who underwent LC,136(3%)underwent cystic duct closure by a PDS loop.Preoperatively,loop closure patients had significantly more complicated biliary disease compared to the clipped closure patients.In the loop closure cohort,zero(0%)bile leakage occurred compared to 59 of 4223(1.4%)clip closure patients.For patients at increased bile leakage risk(risk score≥1)rates were 1.6%and up to 13%(4/30)for clip closure patients with a risk score≥4.This risk increase paralleled a stepwise increase of actual bile leakage complication for clip closure patients,which was not observed for loop closure patients.CONCLUSION Cystic duct closure with a PDS loop during LC may reduce bile leakage in patients at increased risk for bile leakage.

关键词： Laparoscopic cholecystectomy Cystic duct occlusion bile leak Endo-loop

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Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

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World Journal of Clinical Cases 2021年第8期9卷 1803-1813页

作者： Xiao-Xiao Huang Jia-Yi Wu Yan-Nan Bai Jun-Yi Wu Jia-Hui Lv Wei-Zhao Chen Li-Ming Huang Rong-Fa Huang Mao-Lin Yan Department of Hepatobiliary and Pancreatic Surgery Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhou 350001Fujian ProvinceChina

BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for patients with small CBD(CBD diameter≤8 mm),endoscopic sphincterotomy remains the preferred treatment at present,but it also has some drawbacks associated with a series of complications,such as pancreatitis,hemorrhage,cholangitis,and duodenal perforation.To date,few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODS A total of 257 patients without acute cholangitis who underwent LC+LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed.The clinical data were retrospectively collected and analyzed.According to whether the diameter of CBD was larger than 8 mm,257 patients were divided into large CBD group(n=146)and small CBD group(n=111).Propensity score matching(1:1)was performed to adjust for clinical differences.The demographics,intraoperative data,short-term outcomes,and long-term follow-up outcomes for the patients were recorded and compared.RESULTS In total,257 patients who underwent successful LC+LCBDE were enrolled in the study,146 had large CBD and 111 had small CBD.The median follow-up period was 39(14-86)mo.For small CBD patients,the median CBD diameter was 0.6 cm(0.2-2.0 cm),the mean operating time was 107.2±28.3 min,and the postoperative bile leak rate,rate of residual CBD stones(CBDS),CBDS recurrence rate,and CBD stenosis rate were 5.41%(6/111),3.60%(4/111),1.80%(2/111),and 0%(0/111),respectively;the mean postoperative hospital stay was 7.4±3.6 d.For large CBD patients,the median common bile duct diameter was 1.0 cm(0.3-3.0 cm),the mean operating time was 115.7±32.0 min,and the postoperative bile leak rate,rate of residual CBDS,CBDS recurrence rate,and CBD stenosis rate were 5.41%(9/146)

关键词： Common bile duct stones Laparoscopic common bile duct exploration Endoscopic sphincterotomy bile leak Choledochal stenosis Recurrence

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Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks

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Hepatobiliary & Pancreatic Diseases International 2009年第3期8卷 309-311页

作者： Fergal Donnellan Faisal Zeb Garry Courtney Abdur R Aftab Department of Gastroenterology St.Luke's Hospital

BACKGROUND:Endoscopic retrograde cholangiopancrea-tography(ERCP)is widely used to manage post-cholecystectomy bile leaks.However,the best endoscopic intervention remains controversial.We investigated the success of a 7 French double pigtail stent following sphincterotomy in the management of such bile leaks. METHODS:Between July 1998 and June 2008,48 patients were referred for ERCP for presumed post-cholecystectomy bile leaks.leaks were confirmed at ERCP and managed by a combination of sphincterotomy and stent insertion unless contraindicated. RESULTS:bile duct cannulation was successful in 44(91.7%)patients.A leak of the cystic duct was demonstrated in 19(43.2%)patients,the duct of Luschka in 11(25.0%),and the common hepatic duct in 5 (11.4%).Complete transection of the common bile duct occurred in 4 patients.The remaining patients had no cholangiographic evidence of a leak.Sphincterotomy was performed in 34 patients.A 7 French double pigtail plastic stent was placed in all 35 patients with cholangiographic evidence of a bile leak.No bile leaks were demonstrated at a follow-up of 8-16 weeks and all stents were removed successfully. CONCLUSION:The combination of sphincterotomy and insertion of a 7 French double pigtail stent results in excellent outcomes in the management of post-cholecystectomy bile leaks.

关键词： cholecystectomy bile leak sphincterotomy stent insertion

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Classification of iatrogenic bile duct injury

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 459-463页

作者： Wan-Yee Lau Eric C.H.Lai Department of Surgery the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.

关键词： laparoscopic cholecystectomy bile duct injury bile duct stricture bile leak classification

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A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation

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Journal of Clinical and Translational Hepatology 2019年第1期7卷 61-71页

作者： Brian T.Moy John W.Birk Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Orthotopic liver transplantation is the definitive treatment for end-stage liver disease and hepatocellular carcinomas.Biliary complications are the most common complications seen after transplantation,with an incidence of 10-25%.These complications are seen both in deceased donor liver transplant and living donor liver transplant.Endoscopic treatment of biliary complications with endoscopic retrograde cholangiopancreatography(commonly known as ERCP)has become a mainstay in the management post-transplantation.The success rate has reached 80%in an experienced endoscopist's hands.If unsuccessful with ERCP,percutaneous transhepatic cholangiography can be an alternative therapy.Early recognition and treatment has been shown to improve morbidity and mortality in post-liver transplant patients.The focus of this review will be a learned discussion on the types,diagnosis,and treatment of biliary complications post-orthotopic liver transplantation.

关键词： Biliary tract complication Orthotropic liver transplantation Stricture bile leak

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Biliary complications in recipients of living donor liver transplantation:A single-centre study

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World Journal of Hepatology 2021年第12期13卷 2081-2103页

作者： Reginia Nabil Guirguis Ehab Hasan Nashaat Azza Emam Yassin Wesam Ahmed Ibrahim Shereen A Saleh Mohamed Bahaa Mahmoud El-Meteini Mohamed Fathy Hany Mansour Dabbous Iman Fawzy Montasser Manar Salah Ghada Abdelrahman Mohamed Gastroenterology and Hepatology Unit Department of Internal MedicineFaculty of MedicineAin Shams UniversityCairo 11591Egypt Department of General Surgery Faculty of MedicineAin Shams UniversityCairo 11591Egypt Department of Tropical Medicine Faculty of MedicineAin Shams UniversityCairo 11591Egypt

BACKGROUND Biliary complications(BCs)after liver transplantation(LT)remain a considerable cause of morbidity,mortality,increased cost,and graft loss.AIM To investigate the impact of BCs on chronic graft rejection,graft failure and mortality.METHODS From 2011 to 2016,215 adult recipients underwent right-lobe living-donor liver transplantation(RT-LDLT)at our centre.We excluded 46 recipients who met the exclusion criteria,and 169 recipients were included in the final analysis.Donors’and recipients’demographic data,clinical data,operative details and postoperative course information were collected.We also reviewed the management and outcomes of BCs.Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss.RESULTS The overall incidence rate of BCs including biliary leakage,biliary infection and biliary stricture was 57.4%.Twenty-seven(16%)patients experienced chronic graft rejection.Graft failure developed in 20(11.8%)patients.A total of 28(16.6%)deaths occurred during follow-up.BCs were a risk factor for the occurrence of chronic graft rejection and failure;however,mortality was determined by recurrent hepatitis C virus infection.CONCLUSION Biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure;nonetheless,effective management of these complications can improve patient and graft survival.

关键词： Biliary complications Living donor liver transplantation Retrospective analysis bile leak Biliary stricture Risk factors Mortality Graft rejection

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Management of biliary complications after liver transplantation

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World Journal of Hepatology 2015年第29期7卷 2890-2895页

作者： Riccardo Memeo Tullio Piardi Federico Sangiuolo Daniele Sommacale Patrick Pessaux Hepato-Biliary and Pancreatic Surgical Unit GeneralDigestive and Endocrine SurgeryIRCADIHU Mix-SurgInstitute for Minimally Invasive Image-Guided SurgeryUniversity of Strasbourg1 place de l’Hopital Department of General Digestive and Endocrine SurgeryHopital Robert DebréCentre Hospitalier Universitaire de ReimsUniversitéde Reims Champagne-Ardenne

Biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation.

关键词： Biliary complication bile leak Anastomotic stricture Endoscopic treatment Liver transplantation

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