Original CommunicationBilirubin level in the drainage fluid is an early and independent predictor of clinically relevant bile leakage after hepatic resection
Section snippets
Study design
Patients who were scheduled for hepatic resection at the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg between July 2008 and February 2011 were enrolled in this prospective study. Patients who were scheduled for an emergency procedure were excluded as were patients who were younger than 18 years of age and those with an expected lack of compliance. The study protocol was approved by the ethics committee of the University of Heidelberg.
Blood samples were
Patient characteristics and operative results
A total of 265 patients who underwent elective hepatic resection were enrolled prospectively in the study. The clinicopathologic characteristics of these patients are summarized in Table I. The median age of included patients was 62 (range, 21–88) years and the proportion of male patients was 55.1% (n = 146). The median BMI was 25.6 (range, 15.6–43.5) and 53 (20%) patients had a BMI of ≥30. An ASA class of III or IV was present in 133 (50.3%) patients. The majority of patients had metastatic
Discussion
Bile leakage is a serious complication with potentially severe impact on patients' perioperative and long-term outcome after hepatic resection.15 However, few studies are available in which authors specifically aimed to reduce the incidence of this complication, as have been attempts to identify early predictors of bile leakage that might allow rapid diagnosis and efficient management. In part this may be explained by the lack of a uniform definition of this complication. The development of the
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2020, Asian Journal of SurgeryCitation Excerpt :In 2011, the International Study Group of Liver Surgery (ISGLS) proposes a uniform definition and severity grading of BL after hepatobiliary and pancreatic operative therapy.27 Rahhari and colleagues have reported that this definition as well as severity grading of BL correlated with the short-term outcomes like duration of drainage, intensive care unit and hospital stay.8 However, using this severity grading of BL, most of the BL would be classified as Grade B.38–40 What's more, the criterion of the severity grading is based on the impact of BL on patients' clinical management, which cannot reflect the impact of BL on long-term prognosis.
Dr Rahbari and Dr Elbers contributed equally to this work.