Factors Affecting Clinical Course of Postoperative Bile Leakage and Efficacy of Endoscopic Biliary Drainage: A Multi‐Center Retrospective Cohort Study

TL;DR

This study identifies factors that influence the severity of bile leakage after liver and bile surgery and shows that endoscopic drainage is effective in treating it.

Contribution

The study identifies age and time to leak as novel predictors of bile leakage severity and confirms the efficacy of endoscopic drainage.

Findings

Older age and longer time from surgery to bile leak are independent predictors of severe bile leakage.

Endoscopic biliary drainage successfully treated all severe bile leakage cases, with a median drainage period of 18 days.

Most patients with severe bile leakage also required intra-abdominal abscess drainage.

Abstract

Bile leakage is one of the complications after hepatobiliary surgery, causing intra‐abdominal infections, and is sometimes difficult to treat. The purpose of our study was to investigate the factors related to severity and to evaluate the efficacy of endoscopic treatment.

This was a retrospective multicenter cohort study conducted at three tertiary care medical centers. The severity of bile leakage was classified per the International Study Group of Liver Surgery, and Grades B and C (requiring some intervention or reoperation) were considered as severe.

The subjects were 59 patients. The surgical procedures were 31 cholecystectomies, 23 hepatectomies, and five pancreaticoduodenectomies. The severity was Grade A/B/C: 17/40/2. Multivariate logistic regression analysis found that age (unit odds ratio [UOR], 1.09; 95% confidence interval [CI], 1.0–1.19; p = 0.049) and days from surgery to bile leak (UOR, 1.18; 95% CI, 1.04–1.35; p = 0.012) were independent predictors of bile leak severity. Of 40 Grade B biliary leakage patients, 37 patients underwent endoscopic drainage, of which 11 also received intra‐abdominal abscess drainage. Eventually, bile leakage was successfully treated in all patients after several endoscopic drainage sessions, and the median drainage period was 18 days (inter‐quartile range: 13–35).

In the management of bile leakage after hepatobiliary surgery, elderly patients or patients with late onset of bile leak may be at high risk of severity. Endoscopic biliary drainage is considered a safe and effective treatment for severe patients.

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