Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study

Eva Braunwarth; Francesca Ratti; Luca Aldrighetti; Hasan A. Al-Saffar; Melroy A. D`Souza; Christian Sturesson; Richard Linke; Andreas Schnitzbauer; Martin Bodingbauer; Klaus Kaczirek; Daniel Vagg; Giles Toogood; Daniele Ferraro; Giuseppe K. Fusai; Rafael Diaz-Nieto; Hassan Malik; Frederik J.H. Hoogwater; Doris Wagner; Peter Kornprat; Ines Fischer; Reinhold Függer; Georg Göbel; Dietmar Öfner; Stefan Stättner

doi:10.1016/j.hpb.2022.08.009

Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study

Eva Braunwarth, Francesca Ratti, Luca Aldrighetti, Hasan A. Al-Saffar, Melroy A. D`Souza, Christian Sturesson, Richard Linke, Andreas Schnitzbauer, Martin Bodingbauer, Klaus Kaczirek, Daniel Vagg, Giles Toogood, Daniele Ferraro, Giuseppe K. Fusai, Rafael Diaz-Nieto, Hassan Malik, Frederik J.H. Hoogwater, Doris Wagner, Peter Kornprat, Ines FischerReinhold Függer, Georg Göbel, Dietmar Öfner, Stefan Stättner^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.

Methods: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.

Results: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).

Conclusion: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.

Original language	English
Pages (from-to)	54-62
Journal	HPB
Volume	25
Issue number	1
DOIs	https://doi.org/10.1016/j.hpb.2022.08.009
Publication status	Published - Jan-2023

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10.1016/j.hpb.2022.08.009

Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction – A international multicenter studyFinal publisher's version, 4.37 MBLicence: Taverne

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Braunwarth, E., Ratti, F., Aldrighetti, L., Al-Saffar, H. A., D`Souza, M. A., Sturesson, C., Linke, R., Schnitzbauer, A., Bodingbauer, M., Kaczirek, K., Vagg, D., Toogood, G., Ferraro, D., Fusai, G. K., Diaz-Nieto, R., Malik, H., Hoogwater, F. J. H., Wagner, D., Kornprat, P., ... Stättner, S. (2023). Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study. HPB, 25(1), 54-62. https://doi.org/10.1016/j.hpb.2022.08.009

@article{16ad84b8300e478bbba0d05ce0f8f93d,

title = "Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study",

abstract = "Background: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.Methods: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.Results: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).Conclusion: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients{\textquoteright} postoperative course negatively.",

author = "Eva Braunwarth and Francesca Ratti and Luca Aldrighetti and Al-Saffar, {Hasan A.} and D`Souza, {Melroy A.} and Christian Sturesson and Richard Linke and Andreas Schnitzbauer and Martin Bodingbauer and Klaus Kaczirek and Daniel Vagg and Giles Toogood and Daniele Ferraro and Fusai, {Giuseppe K.} and Rafael Diaz-Nieto and Hassan Malik and Hoogwater, {Frederik J.H.} and Doris Wagner and Peter Kornprat and Ines Fischer and Reinhold F{\"u}gger and Georg G{\"o}bel and Dietmar {\"O}fner and Stefan St{\"a}ttner",

note = "Publisher Copyright: {\textcopyright} 2022 International Hepato-Pancreato-Biliary Association Inc.",

year = "2023",

month = jan,

doi = "10.1016/j.hpb.2022.08.009",

language = "English",

volume = "25",

pages = "54--62",

journal = "HPB",

issn = "1365-182X",

publisher = "ELSEVIER SCI LTD",

number = "1",

}

Braunwarth, E, Ratti, F, Aldrighetti, L, Al-Saffar, HA, D`Souza, MA, Sturesson, C, Linke, R, Schnitzbauer, A, Bodingbauer, M, Kaczirek, K, Vagg, D, Toogood, G, Ferraro, D, Fusai, GK, Diaz-Nieto, R, Malik, H, Hoogwater, FJH, Wagner, D, Kornprat, P, Fischer, I, Függer, R, Göbel, G, Öfner, D & Stättner, S 2023, 'Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study', HPB, vol. 25, no. 1, pp. 54-62. https://doi.org/10.1016/j.hpb.2022.08.009

TY - JOUR

T1 - Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction

T2 - A international multicenter study

AU - Braunwarth, Eva

AU - Ratti, Francesca

AU - Aldrighetti, Luca

AU - Al-Saffar, Hasan A.

AU - D`Souza, Melroy A.

AU - Sturesson, Christian

AU - Linke, Richard

AU - Schnitzbauer, Andreas

AU - Bodingbauer, Martin

AU - Kaczirek, Klaus

AU - Vagg, Daniel

AU - Toogood, Giles

AU - Ferraro, Daniele

AU - Fusai, Giuseppe K.

AU - Diaz-Nieto, Rafael

AU - Malik, Hassan

AU - Hoogwater, Frederik J.H.

AU - Wagner, Doris

AU - Kornprat, Peter

AU - Fischer, Ines

AU - Függer, Reinhold

AU - Göbel, Georg

AU - Öfner, Dietmar

AU - Stättner, Stefan

PY - 2023/1

Y1 - 2023/1

N2 - Background: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.Methods: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.Results: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).Conclusion: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.

AB - Background: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.Methods: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.Results: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).Conclusion: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.

U2 - 10.1016/j.hpb.2022.08.009

DO - 10.1016/j.hpb.2022.08.009

M3 - Article

AN - SCOPUS:85137701617

SN - 1365-182X

VL - 25

SP - 54

EP - 62

JO - HPB

JF - HPB

IS - 1

ER -

Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction: A international multicenter study

Abstract

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