Dataset Information

Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction.

ABSTRACT: Background and Aim: The risk factors for bile leakage after hepatectomy without biliary reconstruction are controversial. This study investigated the risk factors for bile leakage after hepatectomy without biliary reconstruction. Methods: We searched databases (Embase (Ovid), Medline (Ovid), PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and May 1, 2021, to evaluate the risk factors for bile leakage after hepatectomy without biliary reconstruction. Results: A total of 16 articles were included in this study, and the overall results showed that sex (OR: 1.21, 95% CI: 1.04-1.42), diabetes (OR: 1.21, 95% CI: 1.05-1.38), left trisectionectomy (OR: 3.53, 95% CI: 2.32-5.36), central hepatectomy (OR: 3.28, 95% CI: 2.63-4.08), extended hemihepatectomy (OR: 2.56, 95% CI: 1.55-4.22), segment I hepatectomy (OR: 2.56, 95% CI: 1.50-4.40), intraoperative blood transfusion (OR:2.40 95%CI:1.79-3.22), anatomical hepatectomy (OR: 1.70, 95% CI: 1.19-2.44) and intraoperative bleeding ≥1,000 ml (OR: 2.46, 95% CI: 2.12-2.85) were risk factors for biliary leakage. Age >75 years, cirrhosis, underlying liver disease, left hepatectomy, right hepatectomy, benign disease, Child-Pugh class A/B, and pre-operative albumin <3.5 g/dL were not risk factors for bile leakage after hepatectomy without biliary reconstruction. Conclusion: Comprehensive research in the literature revealed that sex, diabetes, left trisectionectomy, central hepatectomy, extended hemihepatectomy, segment I hepatectomy, intraoperative blood transfusion, anatomical hepatectomy and intraoperative bleeding ≥1,000 ml were risk factors for biliary leakage.

SUBMITTER: Tan L

PROVIDER: S-EPMC8591075 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction.

Tan Ling L Liu Fei F Liu Zi-Lin ZL Xiao Jiang-Wei JW

Frontiers in surgery 20211101

<b>Background and Aim:</b> The risk factors for bile leakage after hepatectomy without biliary reconstruction are controversial. This study investigated the risk factors for bile leakage after hepatectomy without biliary reconstruction. <b>Methods:</b> We searched databases (Embase (Ovid), Medline (Ovid), PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and May 1, 2021, to evaluate the risk factors for bile leakage after hepatectomy without biliary re ...[more]

PMID: 34790696

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Project description:Open surgery is the standard of care for perihilar cholangiocarcinoma (pCCA). With the aim of oncologic radicality, it requires a complex major hepatectomy with biliary reconstruction. The postoperative course is consequently often complicated, with severe morbidity and mortality rates of up to 27.5-54% and 18%, respectively. Robotic liver surgery is emerging as a safe, minimally-invasive technique with huge potential for pCCA management. After the first case described by Giulianotti in 2010, here we present the first western series of robot-assisted liver resections with biliary reconstruction for pCCA with the aim to preliminarily assess the feasibility and repeatability of the procedure. At our high-volume teaching hospital center dedicated to HPB surgery, 128 pCCA patients have been surgically treated in the last 15 years whereas more than 800 laparoscopic liver resections have been performed. Since the Da Vinci Xi Robotic platform was introduced in late 2018, 6 major robotic liver resections with biliary reconstruction have been performed, 4 of which were for pCCA. All 4 cases involved a left hepatectomy with caudate lobectomy. The median operating time was 840 min, with a median blood loss of 700 ml. One case was converted to open surgery during the reconstruction due to a short mesentery preventing the hepatico-jejunostomy. None of the patients experienced major complications, while minor complications occurred in 3 out of 4 cases. One biliary leak was managed conservatively. The median postoperative stay was 9 days. Negative biliary margins were achieved in 3 of the 4 cases. An included video clip shows the most relevant technical details. This preliminary series demonstrates that robot-assisted liver resection for pCCA is feasible. We speculate that the da Vinci platform has a relevant potential in pCCA surgery with particular reference to the multi-duct biliary reconstruction. Further studies are needed to better clarify the role of this high-cost technology in the minimally-invasive treatment of pCCA.

Dataset Information

Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction.

Publications

Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction.

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