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Original Article
July 1, 2006

Bile Leakage and Liver Resection: Where Is the Risk?

Author Affiliations

Author Affiliation: Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Italy.

Arch Surg. 2006;141(7):690-694. doi:10.1001/archsurg.141.7.690

Hypothesis  The knowledge of risk factors for bile leakage after liver resection could reduce its incidence.

Design  Retrospective study.

Setting  Tertiary care referral center.

Patients  The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.

Interventions  Liver resections without biliary anastomoses.

Main Outcome Measures  Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.

Results  Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P<.001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.

Conclusions  Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.