Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery

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• 作者：Moritz Koch MD^a ; O. James Garden MD^b ; Robert Padbury MD^c ; Nuh N. Rahbari MD^a ; Rene Adam MD^d ; Lorenzo Capussotti MD^e ; Sheung Tat Fan MD^f ; Yukihiro Yokoyama MD^g ; Michael Crawford MD^h ; Masatoshi Makuuchi MDⁱ ; Christopher Christophi MD^j ; Simon Banting MD^k ; Mark Brooke-Smith MD^l ; Val Usatoff MD^m ; Masato Nagino MD^g ; Guy Maddern MDⁿ ; Thomas J. Hugh MD^o ; Jean-Nicolas Vauthey MD^p ; Paul Greig MD^q ; Myrddin Rees MD^r ; Yuji Nimura MD^g ; Joan Figueras MD^s ; Ronald P. DeMatteo MD^t ; Markus W. Bü ; chler MD^a ; ^{markus.buechler@med.uni-heidelberg.de} ; Jü ; rgen Weitz MD^a
• 刊名：Surgery
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：149
• 期：5
• 页码：680-688
• 全文大小：136 K

文摘

Background

Despite the potentially severe impact of bile leakage on patients’ perioperative and long-term outcome, a commonly used definition of this complication after hepatobiliary and pancreatic operations has not yet been established. The aim of the present article is to propose a uniform definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy.

Methods

An international study group of hepatobiliary and pancreatic surgeons was convened. A consensus definition of bile leakage after hepatobiliary and pancreatic operative therapy was developed based on the postoperative course of bilirubin concentrations in patients’ serum and drain fluid.

Results

After evaluation of the postoperative course of bilirubin levels in the drain fluid of patients who underwent hepatobiliary and pancreatic operations, bile leakage was defined as bilirubin concentration in the drain fluid at least 3 times the serum bilirubin concentration on or after postoperative day 3 or as the need for radiologic or operative intervention resulting from biliary collections or bile peritonitis. Using this criterion severity of bile leakage was classified according to its impact on patients’ clinical management. Grade A bile leakage causes no change in patients’ clinical management. A Grade B bile leakage requires active therapeutic intervention but is manageable without relaparotomy, whereas in Grade C, bile leakage relaparotomy is required.

Conclusion

We propose a simple definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy. The application of the present proposal will enable a standardized comparison of the results of different clinical trials and may facilitate an objective evaluation of diagnostic and therapeutic modalities in the field of hepatobiliary and pancreatic operative therapy.