Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.67
Peer-review started: October 26, 2023
First decision: November 8, 2023
Revised: November 9, 2023
Accepted: December 20, 2023
Article in press: December 20, 2023
Published online: January 27, 2024
Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.
To evaluate the incidence, risk factors, and management of bile leakage after open hepatectomy in patients with biliary tract cancer.
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.
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.
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.
Core Tip: Bile leakage is a common complication of open hepatectomy for biliary tract cancer; however, it can be managed conservatively in most cases. The incidence of bile leak was 16.7% and was primarily grade A according to the liver surgery classification. The most common site was the cut surface of the liver. Treatment involved conservative measures such as drainage and antibiotics, with some cases requiring endoscopic or percutaneous intervention. Male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion were identified as risk factors for bile leakage. Awareness of these factors can help optimize management strategies and reduce the occurrence of bile leaks.