Hepatocholangiojejunostomy is a high-risk factor for the evidence of bile leakage after hepatectomy

Abstract

Bile leaks occurring after hepatectomy most seriously compromise patients’quality of life immediately after operation and contribute to increasing healthcare costs. The incidence of bile leaks has been reported to range from 4％ to 12.8％. In patients who undergo hepatocholangiojejunostomy, the incidence increases. We studied the incidences of bile leaks and intra-abdominal abscess among 530 patients who underwent simple hepatectomy or hepatectomy with biliary tract reconstruction. Among the patients who underwent simple hepatectomy, 20 patients （4.3％）had bile leaks, and 5 patients （1.1％）had intra-abdominal abscess. Among the patients who underwent biliary tract reconstruction, 13 patients （21.7％）had bile leaks, and 2 patients （3.3％）had intra-abdominal abscess. Many patients who underwent biliary tract reconstruction had bile leaks, but the incidence of intra-abdominal abscess can apparently be decreased by applying closed suction drainage. Intraperitoneal drainage cultures were positive in 100％ of the patients who underwent biliary tract reconstruction. The causative organisms included enterococci, Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species, which may have been derived from the intestinal tract. The incidence of bile leaks is high in patients who undergo hepatectomy with biliary tract reconstruction, and it is important to prevent intra-abdominal abscess by performing drainage and taking other precautions.