Bile leak after hepatectomy: Predictive factors of spontaneous healing

Abstract 

Background

Bile leakage after hepatectomy usually has spontaneous healing, but some patients require interventional procedures. To identify early predictive factors of conservative management failure.

Methods

This study focused on patients with bile leak after hepatectomy without extrahepatic biliary resection from 1996 through 2006.

Results

Bile leakage occurred in 34 of 593 patients (5.7%). Conservative management was successful in 26 patients (76.5%). At univariate analysis overall associated resections, vascular associated resections, and drainage output on days 1, 3, and 10 from leak onset were significant negative predictors of spontaneous healing. At multivariate analysis drainage output greater than 100 mL on day 10 was the only independent prognostic factor of conservative management failure (relative risk, 55.985; P = .008) with 80% sensitivity, 93.3% specificity, and 90% accuracy.

Conclusions

Wait-and-see treatment is successful in most cases. Patients with drainage output greater than 100 mL 10 days after bile leakage diagnosis should be scheduled for interventional treatments.

Keywords: Liver surgery, Bile leak, ERCP, Postoperative morbidity