Bile Leakage After Liver Resection

Abstract

The aim of the literature review was to present the modern statement of frequency, classifications, management and risk factors of bile leakage after hepatectomy. Objectives. Our retrospective study includes 363 consecutive patients that underwent liver resection. Results. The incidence of bile leakage was found to be 7,7%: bilomas appeared in 5,2% and external bile fistulas - in 2,5%. Ten from 19 bilomas were treated by percutaneous puncture under ultrasound control. Procedure was repeated from one to four times. Nine patients were treated with percutaneous drainage. After that 8 external bile leakages were stopped during 4-12 weeks. One patient had the dilatation of common bile duct. She underwent endoscopic papillotomy. Among nine patients with external bile leakage six were treated conservatively. Central type leakage (2) that was in communication with bile duct of the fourth segment was treated with endoscopic retrograde 7 and 10 Fr stent with 9 and 11 cm length. Stent was placed to left and common bile ducts. Bile leakage stopped during 2-3 days. One patient was reoperated. Multivariate analysis indentified only one independent factor that was significantly correlated with the occurrence of bile leakage: right hepatectomy. More meticulous management is needed to prevent bile leakage in high-risk patients. Conclusion. Endoscopic retrograde stent appeared quick and successful in cases of central type leakage that was in communication with segmental bile duct.