Management of bilioenteric anastomosis leakage after major liver resection

Abstract

BACKGROUND: Post-hepatectomy bile leakage is a challenging issue that can lead to morbidities and mortality after liver resection. This leakage can occur either from a bilioenteric anastomosis (BEA) or from the transected surface of the liver. This study investigated the incidence, risk factors, and effective management of BEA leakage after major liver resection. METHODS: Bile leakage was diagnosed through drain fluid analysis based on the International Study Group of Liver Surgery definition. Leakage from a BEA was confirmed via fluoroscopy during percutaneous interventions or reoperation. Perioperative data and data on the management of patients with BEA leakage were collected and analysed. Bivariate analysis used Mann-Whitney U and χ2 tests, and binary logistic regression identified risk factors for BEA leakage, with variables having P < 0.200 included in multivariable analysis. RESULTS: Of 2936 patients undergoing hepatectomy between 2008 and 2023, 229 underwent liver resection with BEA. Leakage from the BEA was identified in 44 patients (19.2%). These patients had a higher rate of post-hepatectomy haemorrhage (P = 0.005), major complications (P = 0.001), BEA stenosis (P = 0.006), and mortality (P = 0.043). The success rate of the management of BEA leakage was 70% for reoperation and 58% for percutaneous transhepatic cholangiography and drainage (PTCD). CONCLUSION: BEA leakage after major liver resection is a severe complication associated with higher morbidity and mortality rates. Surgical treatment appeared to be more successful than PTCD in the early postoperative phase. PTCD proved to be a valuable additional therapy option following reoperation. These conclusions should be taken with caution and need to be confirmed through further prospective studies.