Mehrabi Arianeb, Abbasi Dezfouli Sepehr, Schlösser Fabian, Ramouz Ali, Khajeh Elias, Ali-Hasan-Al-Saegh Sadeq, Loos Martin, Strobel Oliver, Müller-Stich Beat, Berchtold Christoph, Mieth Markus, Klauss Miriam, Chang De-Hua, Wielpütz Mark O, Büchler Markus W, Hackert Thilo
Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany.
Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany.
Eur J Surg Oncol. 2022 Dec;48(12):2440-2447. doi: 10.1016/j.ejso.2022.06.030. Epub 2022 Jun 24.
Hepaticoenterostomy is an important step of reconstruction during hepatopancreatobiliary (HPB) surgery with a subsequent bile leakage rate of up to 5%. The International Study Group of Liver Surgery (ISGLS) proposed a severity grading system for defining bile leakage after HPB surgery, which has not been validated after pancreatic surgery in a large patient cohort. The present study aimed to validate the ISGLS definition for bile leakage in pancreatic surgery and to investigate the postoperative outcomes of bile leakage after pancreatic resections.
Data from the prospectively maintained database for pancreas surgery were extracted for any type of pancreatectomy with hepaticoenterostomy between 2006 and 2019. The severity of bile leakage was graded according to the ISGLS definition. The influence of our standardized hepaticoenterostomy technique and of the complexity of the surgical procedure on the rate of clinically relevant bile leakages (B and C) were assessed in three different timeframes.
Bile leakage was detected in 152 of 5,300 patients (2.9%). Clinically relevant bile leakages included seventy patients with grade B and eighty-two patients with grade C bile leakages (46.1% and 53.9%, respectively). During the study period, the overall rate of bile leakage showed to be stable (from 3.5% to 2.4%). Patients with grade C bile leakage had a higher rate of postoperative wound infection (P < 0.001) and longer ICU stays and hospital stays compared to patients with grade B bile leakage (P = 0.03 and P < 0.001 respectively). These parameters were significantly higher in patients with late grade C bile leakage but were similar between patients with grade B bile leakage and early grade C bile leakage (<5th day POD). In the whole patients' cohort, the 90-day mortality rate was 3.2% (174/5,300), with a rate of 25% in patients with bile leakage (38/152).
The ISGLS classification is a valid method for classifying postoperative bile leak after pancreas surgery. Standardization of our hepaticoenterostomy technique resulted in a stable rate of bile leakage. Although rare, bile leakage following pancreas surgery is a severe complication that has a major impact on patient outcomes and contributes significantly to morbidity and mortality, even in the absence of POPF.
肝肠吻合术是肝胰胆（HPB）手术重建的重要步骤，术后胆漏发生率高达5%。国际肝脏手术研究组（ISGLS）提出了一种用于定义HPB手术后胆漏的严重程度分级系统，但在大量胰腺手术患者队列中尚未得到验证。本研究旨在验证ISGLS对胰腺手术中胆漏的定义，并调查胰腺切除术后胆漏的术后结局。
提取2006年至2019年间接受任何类型胰十二指肠切除术并进行肝肠吻合术的前瞻性维护胰腺手术数据库中的数据。根据ISGLS定义对胆漏的严重程度进行分级。在三个不同时间段评估我们标准化的肝肠吻合术技术和手术复杂性对临床相关胆漏（B级和C级）发生率的影响。
5300例患者中有152例（2.9%）检测到胆漏。临床相关胆漏包括70例B级胆漏患者和82例C级胆漏患者（分别占46.1%和53.9%）。在研究期间，胆漏的总体发生率显示稳定（从3.5%降至2.4%）。与B级胆漏患者相比，C级胆漏患者术后伤口感染率更高（P<0.001），ICU住院时间和住院时间更长（分别为P=0.03和P<0.001）。这些参数在晚期C级胆漏患者中显著更高，但在B级胆漏患者和早期C级胆漏患者（术后第5天之前）之间相似。在整个患者队列中，90天死亡率为3.2%（174/5300），胆漏患者的死亡率为25%（38/152）。
ISGLS分类是一种用于对胰腺手术后术后胆漏进行分类的有效方法。我们肝肠吻合术技术的标准化导致胆漏发生率稳定。尽管罕见，但胰腺手术后的胆漏是一种严重并发症，对患者结局有重大影响，即使在没有胰瘘的情况下，也对发病率和死亡率有显著贡献。
