Management Outcomes of Biliary Complications after Major Liver Resection in a Single Hepato-Biliary Center

Muhammad  Ali; Nasir  Mehmud; Maham  Saqib; Muhammad  Shoaib; Muhammad  Naeem; Syed Daood  Hashmi

doi:10.51253/pafmj.v76iSUPPL-1.11917

Authors

Muhammad Ali Department of Surgery, Army Liver Transplant Unit, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Nasir Mehmud Department of Surgery, Army Liver Transplant Unit, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Maham Saqib Department of Diagnostic Radiology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Shoaib Department of Surgery, Army Liver Transplant Unit, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Naeem Department of General Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Syed Daood Hashmi Department of General Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.11917

Keywords:

Biliary tree, Complications, Hepatectomy, Outcomes

Abstract

Objectives: To determine frequency of various biliary tree complications after hepatectomy, management measures adopted for their management and their outcomes.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Army Liver Transplant Unit, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jun 2023 to Jan 2024.

Methodology: A total of 78 patients who underwent major liver resection were included in the study. Patients were assessed for occurrence of biliary complications, management measures adopted for their management and their outcomes.

Results: In this study, 8(10.26%) patients developed biliary complications [5(62.50%) bile leakage, 2(25.00%) anastomosis stricture and 1(12.50%) biloma formation]. 4(80.00%) patients with bile leakage (n=5) were managed by ERCP and 1(20.00%) by PTC. Both patients with anastomosis stricture were managed by ERCP. Patient with biloma was managed by ultrasound guided drainage. All patients were successfully treated 8(100%). Overall 2(2.56%) patients developed biliary peritonitis and both had hepatectomy related bile leakage. Mean hospitalization length was 7.92±1.10 days. Overall mortality rate was 7(8.97%). Among patients who developed biliary complications (n=8); 2(25.00%) died while among patients who did not develop biliary complications (n=70); 5(6.41%) patients died, (p=0.094).

Conclusion: Frequency of biliary complications in patients who undergo major liver resection is 10.26% with biliary leakage being most common biliary complication.

Downloads

Download data is not yet available.

References

1. Itoh T, Miyajima A. Liver regeneration by stem/progenitor cells. Hepatology 2014; 59(4): 1617-1626.

https://doi.org/10.1002/hep.26753

2. Swaid F, Downs D, Rosemurgy AS. A practical approach to liver metastasis from unknown primary cancer: What surgeons need to know. Cancer Genet 2016; 209(12): 559-566.

https://doi.org/10.1016/j.cancergen.2016.08.004

3. Roayaie S, Jibara G, Tabrizian P, Park JW, Yang J, Yan L, et al. The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology 2015; 62(2): 440-451.

https://doi.org/10.1002/hep.27745

4. Lv X, Zhang L, Yu X, Yu H. The difficulty grade of laparoscopic hepatectomy for hepatocellular carcinoma correlates with long-term outcomes. Updates Surg 2023; 75: 881–888. https://doi.org/10.1007/s13304-023-01452-4

5. Faria LL, Darce GF, Bordini AL, Herman P, Jeismann VB, de Oliveira IS, et al. Liver surgery: important considerations for pre- and postoperative imaging. Radiographics 2022; 42(3): 722-740. https://doi.org/10.1148/rg.210124

6. Allaire M, Goumard C, Lim C, Le Cleach A, Wagner M, Scatton O. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep 2020; 2(4): 100134.

https://doi.org/10.1016/j.jhepr.2020.100134

7. Diggs LP, Aversa JG, Wiemken TL, Martin SP, Drake JA, Ruff SM, et al. Patient comorbidities drive high mortality rates associated with major liver resections irrespective of hospital volume. Am Surg 2021; 87(7): 1163-1170.

https://doi.org/10.1177/0003134820973368

8. Li B, Qin Y, Qiu Z, Ji J, Jiang X. A cohort study of hepatectomy-related complications and prediction model for postoperative liver failure after major liver resection in 1,441 patients without obstructive jaundice. Ann Transl Med 2021; 9(4): 305.

https://doi.org/10.21037/atm-20-5472

9. Lee J, Song O, Park HM, Lee SY, Kim CH, Kim HR. Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy: A case report. Medicine 2021; 100(46): e27877.

https://doi.org/10.1097/MD.0000000000027877

10. Kokudo N, Takemura N, Ito K, Mihara F. The history of liver surgery: Achievements over the past 50 years. Ann Gastroenterol Surg 2020; 4(2): 109-117.

https://doi.org/10.1002/ags3.12322

11. Coletta D, Ossola P, Parrino C, Oddi A, D'Annibale M, Perri P, et al. Robotic liver resections: application of difficulty score systems to an initial experience. is a specific robotic difficulty score necessary? J Laparoendosc Adv Surg Tech 2020; 30(11): 1177-1182. https://doi.org/10.1089/lap.2020.0119

12. Liu Y, Liu L. Changes in the epidemiology of hepatocellular carcinoma in Asia. Cancers 2022; 14(18): 4473.

https://doi.org/10.3390/cancers14184473

13. Albarrak J, Al-Shamsi H. Current status of management of hepatocellular carcinoma in the gulf region: challenges and recommendations. Cancers 2023; 15(7): 2001.

https://doi.org/10.3390/cancers15072001

14. Khan MR, Begum S. Mandatory multidisciplinary management of hepatocellular carcinoma: Need of the hour in a country with high prevalence of hepatitis C virus infection. J Pak Med Assoc 2021; 71(5): 1455-1457.

https://doi.org/10.47391/JPMA.705

15. Nevola R, Tortorella G, Rosato V, Rinaldi L, Imbriani S, Perillo P, et al. Gender differences in the pathogenesis and risk factors of hepatocellular carcinoma. Biology 2023; 12(7): 984.

https://doi.org/10.3390/biology12070984

16. Xi C, Zhu M, Ji T, Tan Y, Zhuang L, Yuan Z, et al. A novel difficulty scoring system of laparoscopic liver resection for liver tumor. Front Oncol 2022; 12: 1019763.

https://doi.org/10.3389/fonc.2022.1019763

17. Kubo N, Shirabe K. Treatment strategy for isolated bile leakage after hepatectomy: Literature review. Ann Gastroenterol Surg 2019; 4(1): 47-55.

https://doi.org/10.1002/ags3.12303

18. Kar I, Qayum K, Sofi J. Indications and complications of hepatic resection patients at Sher-I-Kashmir Institute of Medical Sciences: An observational study. Cureus 2021; 13(11): e19713.

https://doi.org/10.7759/cureus.19713

19. Spetzler VN, Schepers M, Pinnschmidt HO, Fischer L, Nashan B, Li J. The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr 2019; 8(2): 101-110.

https://doi.org/10.21037/hbsn.2019.02.06

20. Filmann N, Walter D, Schadde E, Bruns C, Keck T, Lang H, et al. Mortality after liver surgery in Germany. Br J Surg 2019; 106(11): 1523-1529.

https://doi.org/10.1002/bjs.11236

21. Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Stukenborg GJ, et al. Clinical factors and postoperative impact of bile leak after liver resection. J Gastrointest Surg 2018; 22(4): 661-667.

https://doi.org/10.1007/s11605-017-3650-4