Postoperative bile leak after hepato-pancreato-biliary surgery in malignant biliary obstruction: rates, treatments, and outcomes in a high-volume tertiary referral center.

Autor: Kokas B; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary., Ulmann L; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary., Rozman P; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary., Farkas N; Institute of Bioanalysis, University of Pécs, Pécs, Hungary., Szijártó A; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary., Szücs Á; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary. szucs.akos@gmail.com.
Jazyk: angličtina
Zdroj: BMC surgery [BMC Surg] 2024 Dec 23; Vol. 24 (1), pp. 410. Date of Electronic Publication: 2024 Dec 23.
DOI: 10.1186/s12893-024-02721-8
Abstrakt: Background: Biliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians.
Objective: This study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center.
Methods: A retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021. Data from patients with malignant biliary obstruction was analyzed collectively and in two homogenous cohorts: distal malignant (DM) group with distal biliary obstruction undergoing pancreatic head resection, proximal malignant (PM) group with perihilar biliary obstruction undergoing perihilar biliary resection without liver resection.
Results: 724 patients were found. After exclusions, 410 remained in the DM and 41 in the PM group. In the DM group the leak rate was 5.6% (23/410). Mortality was 3.9%, in patients with anastomotic failure 26% (6/23) vs no failure 2.6% (10/387) (p‹0.0001). Leak rate in the ASA III and ASA I-II patients were 52.2% (12/23) vs 48.8% (11/23), (p = 0.597). Leak rates were higher in the PM group 14,6% (6/41), mortality was 4.9% (2/41). All leaks in the PM group occurred in ASA III patients (6/6). No statistically significant associations were found between leak rates and factors such as patient age, preoperative serum bilirubin levels, preoperative or intraoperative biliary drainage, cholangitis, blood transfusion, postoperative pancreatic fistula, or bile duct dilation in either group. Bile leaks (n = 29) were treated conservatively (n = 9) with percutaneous transhepatic drainage (n = 3) or reoperation with (n = 16) or without (n = 10) external biliary drainage. Clinical success rates were slightly higher after reoperation with external drainage.
Conclusion: This study identified perihilar resection as a risk factor for biliary leakage and trends indicating higher leak rates among patients with advanced comorbidities (ASA III), elevated preoperative bilirubin levels, non-dilated bile ducts, cholangitis or postoperative pancreatic fistula but these associations did not reach statistical significance, likely due to the limited sample size. In the management of anastomotic leakage, conservative and minimally invasive methods are effective; however, most cases required relaparotomy combined with external biliary drainage.
Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Semmelweis University Regional and Institutional Committee of Science and Research Ethics (SE RKEB #25/2023). The informed consent is waived by the mentioned ethics committee considering the retrospective nature of the study. Consent for publication: Not applicable. The records were fully anonymized during the data analysis, and the ethics committee did not require informed consent. The authors had no access to information that could identify individual participants during or after data collection. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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