Incidence and risk factors of biliary leaks after partial hepatectomy within an enhanced recovery perioperative pathway: a single-center retrospective cohort study.

Abstract

Purpose: Biliary leak is a specific and frequent complication after hepatectomy. This study aimed to assess the incidence and risk factors of biliary leak after hepatectomy.

Methods: A retrospective cohort study was performed. All consecutive patients who underwent hepatectomy between January 2013 and June 2022 were included. Abdominal drainage was performed in case of biliary anastomosis or major hepatectomy. Biliary leak was defined and classified according to the International Study Group for Liver Surgery definition with grades A, B, C based on the required management. Logistic binary regression was used to find risk factors.

Results: Data were collected from 565 patients who underwent hepatectomy during the study period. Biliary leaks occurred in 10% (55/565) of patients. The rates of biliary leak grades A, B, and C were 18% (10/55), 37% (20/55), and 45% (25/55), respectively. A high nutrition risk screening (OR 2.1, 95% CI 1.3-3.4), preoperative biliary drainage (OR 4.6, 95% CI 1.5-13.5), and intraoperative biliary anastomosis (OR 3.4, 95% CI 1.3-8.9) were found as independent risk factors for biliary leak on multivariable analysis. In terms of morbidity, biliary leak patients had more infectious complications (46% vs. 8%, p < 0.001) and a longer median hospital stay (26 vs. 7 days, p < 0.001). Regarding treatment, 41 (75%) patients with biliary leak underwent drainage either endoscopically or percutaneously.

Conclusion: Preoperative biliary drainage, high nutrition risk screening, and intraoperative biliary anastomosis were independent predictive factors for postoperative biliary leaks. Most frequent treatments of biliary leaks after hepatectomy were antibiotics and drainage.