Hepatobiliary anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks.

IF 3.8 Q2 GASTROENTEROLOGY & HEPATOLOGY
Translational gastroenterology and hepatology Pub Date : 2024-09-13 eCollection Date: 2024-01-01 DOI:10.21037/tgh-24-9
Olivia Rennie, Manaswi Sharma, Nour Helwa
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引用次数: 0

Abstract

Background and objective: Hepatobiliary diseases are a longstanding and significant medical challenge which, despite advances in surgical techniques, still carry risks for postoperative complications such as anastomotic leaks (ALs), which can include both postoperative pancreatic fistula (POPF) and bile leaks (BL). These complications incur significant human and economic costs on all those involved, including the patient, healthcare providers, and hospital systems. The aim of this study was to construct a narrative review of literature surrounding definitions and grading systems for ALs in the context of hepato-pancreato-biliary (HPB) procedures, and consequences of POPF and BL.

Methods: A literature review was conducted by examining databases including PubMed, Web of Science, OVID Embase, Google Scholar, and Cochrane library databases. Searches were performed with the following search criteria: (((((((anastomosis) OR (anastomotic leak*)) OR (postoperative pancreatic fistula)) OR (bile leak*)) OR (pancreaticoduodenectomy)) OR (whipple)) AND ((hepatobiliary) OR (hepato-pancreato-biliary)) AND ((definition) OR (grading system*) OR (consequences) OR (outcomes) OR (risk factor*) OR (morbidity) OR (mortality))). Publications that were retrieved underwent further assessment to ensure other relevant publications were identified and included.

Key content and findings: A universally accepted definition and grading system for POPF and BL continues to be lacking, leading to variability in reported incidence in the literature. Various groups have worked to publish guidelines for defining and grading POPF and BL, with the International Study Group in Pancreatic Surgery (ISGPS) and International Study Group for Liver Surgery (ISGLS) definitions the current most recommended definitions for POPF and BL, respectively. The burden of AL on patients, healthcare providers, and hospitals is well documented in evidence from leak consequences, such as increased morbidity and mortality, higher reoperation rates, and increased readmission rates, among others.

Conclusions: AL remains a significant challenge in HPB surgery, despite medical advancements. Understanding the progress made in defining and grading leaks, as well as the range of negative outcomes that arise from AL, is crucial in improving patient care, reduce surgical mortality, and drive further advancements in earlier detection and treatment of AL.

肝胆吻合口渗漏:关于渗漏的定义、分级系统和后果的叙述性综述。
背景和目的:肝胆疾病是一项长期存在的重大医学挑战,尽管手术技术不断进步,但术后仍有可能出现吻合口漏(AL)等并发症,其中包括术后胰瘘(POPF)和胆漏(BL)。这些并发症会给患者、医疗服务提供者和医院系统等所有相关人员带来巨大的人力和经济损失。本研究旨在对肝胰胆(HPB)手术中 AL 的定义和分级系统,以及 POPF 和 BL 的后果等相关文献进行叙述性综述:文献综述是通过研究包括 PubMed、Web of Science、OVID Embase、Google Scholar 和 Cochrane 图书馆数据库在内的数据库进行的。检索标准如下:(((((((anastomosis) OR (anastomotic leak*))或(术后胰瘘))或(胆漏*))。或(胰十二指肠切除术))或(Whipple))和((肝胆)或(肝-胰-胆))和((定义)或(分级系统*)或(后果)或(结果)或(风险因素*)或(发病率)或(死亡率)))。对检索到的出版物进行进一步评估,以确保确定并纳入其他相关出版物:目前仍缺乏公认的 POPF 和 BL 的定义和分级系统,导致文献中报告的发病率存在差异。不同团体已致力于发布 POPF 和 BL 的定义和分级指南,其中国际胰腺外科研究组(ISGPS)和国际肝脏外科研究组(ISGLS)的定义分别是目前最推荐的 POPF 和 BL 的定义。AL对患者、医疗服务提供者和医院造成的负担已在泄漏后果的证据中得到充分证明,如发病率和死亡率增加、再次手术率升高、再次入院率升高等:结论:尽管医疗技术在不断进步,但AL仍是HPB手术中的一项重大挑战。了解在漏孔定义和分级方面取得的进展以及 AL 导致的一系列不良后果,对于改善患者护理、降低手术死亡率以及推动早期检测和治疗 AL 的进一步发展至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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