Post-hepatectomy Biliary Leaks: Analysis of Risk Factors and Development of a Simplified Predictive Scoring System

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2023 Jan 24

PMID 36692605

Authors

Shraddha Patkar

Aditya Kunte

Sridhar Sundaram

Mahesh Goel

Affiliations

Soon will be listed here.

Abstract

Purpose: Most studies identifying risk factors for post-hepatectomy biliary leaks (PHBLs) have relatively small proportions of major hepatectomies. A simplified predictive score to identify high risk patients is necessary in order to investigate the efficacy of mitigation strategies.

Methods: A retrospective analysis of a prospectively maintained database of liver resections from a high-volume cancer center was performed. Multivariate regression was utilized for identification of risk factors and development of the predictive score.

Results: A total of 862 patients underwent a curative hepatic resection over 10 years, of whom 146 (16.9%) developed a biliary leak; 85 (9.86%), 52 (6.03%), and 9 (1.04%) patients had a grade A, B, and C leak respectively. A biliary-enteric anastomosis [OR 5.1 (95% CI 2.45-10.58); p < 0.001], a central [OR 4.33 (95% CI 1.25-14.95); p = 0.021] or an extended hepatectomy [OR 4.29 (95% CI 1.52-12.12); p = 0.006], liver steatosis [OR 2.28 (95% CI 1.09-4.77); p = 0.027], and blood loss of ≥ 2000 mL [OR 2.219 (95% CI 1.15-4.27); p = 0.017] were identified as independent predictors of a clinically significant biliary leak and were assigned 1 point each to develop the biliary leak score. Clinically significant biliary leaks were seen in 11 (2.79%), 20 (6.38%), 19 (15.4%), 9 (56.3%), and 1 (100%) patients with scores of 0, 1, 2, 3, and 4 respectively (p < 0.001).

Conclusion: A biliary-enteric anastomosis, a central or extended hepatectomy, liver steatosis, and blood loss ≥ 2L combined result in a simple predictive score for clinically significant biliary leaks.

Citing Articles

Impact of post-hepatectomy biliary leaks on long-term survival in different liver tumors: A single institute experience.

Ballal D, Patkar S, Kunte A, Sundaram S, Shetty N, Gala K Ann Hepatobiliary Pancreat Surg. 2024; 28(4):451-457.

PMID: 39013882 PMC: 11599820. DOI: 10.14701/ahbps.24-078.

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