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External biliary drainage following major liver resection for perihilar cholangiocarcinoma: impact on development of liver failure and biliary leakage.

Authors :
Olthof PB
Coelen RJ
Wiggers JK
Besselink MG
Busch OR
van Gulik TM
Source :
HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2016 Apr; Vol. 18 (4), pp. 348-53. Date of Electronic Publication: 2016 Feb 18.
Publication Year :
2016

Abstract

Background: Preoperative biliary drainage is considered essential in perihilar cholangiocarcinoma (PHC) requiring major hepatectomy with biliary-enteric reconstruction. However, evidence for postoperative biliary drainage as to protect the anastomosis is currently lacking. This study investigated the impact of postoperative external biliary drainage on the development of post-hepatectomy biliary leakage and liver failure (PHLF).<br />Methods: All patients who underwent major liver resection for suspected PHC between 2000 and 2015 were retrospectively analyzed. Biliary leakage and PHLF was defined as grade B or higher according to the International Study Group of Liver Surgery (ISGLS) criteria.<br />Results: Eighty-nine out of 125 (71%) patients had postoperative external biliary drainage. PHLF was more prevalent in the drain group (29% versus 6%; P = 0.004). There was no difference in the incidence of biliary leakage (32% versus 36%). On multivariable analysis, postoperative external biliary drainage was identified as an independent risk factor for PHLF (Odds-ratio 10.3, 95% confidence interval 2.1-50.4; P = 0.004).<br />Conclusions: External biliary drainage following major hepatectomy for PHC was associated with an increased incidence of PHLF. It is therefore not recommended to routinely use postoperative external biliary drainage, especially as there is no evidence that this decreases the risk of biliary anastomotic leakage.<br /> (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1477-2574
Volume :
18
Issue :
4
Database :
MEDLINE
Journal :
HPB : the official journal of the International Hepato Pancreato Biliary Association
Publication Type :
Academic Journal
Accession number :
27037204
Full Text :
https://doi.org/10.1016/j.hpb.2015.11.007