Rennie Olivia, Sharma Manaswi, Helwa Nour
FluidAI Medical (formerly NERv Technology Inc.), Kitchener, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Transl Gastroenterol Hepatol. 2024 Sep 13;9:70. doi: 10.21037/tgh-24-9. eCollection 2024.
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.
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.
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.
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.
肝胆疾病一直是重大的医学挑战，尽管手术技术有所进步，但术后仍有发生吻合口漏（AL）等并发症的风险，其中包括术后胰瘘（POPF）和胆漏（BL）。这些并发症给包括患者、医护人员和医院系统在内的所有相关方带来了巨大的人力和经济成本。本研究的目的是对肝胰胆（HPB）手术中AL的定义和分级系统以及POPF和BL的后果相关文献进行叙述性综述。
通过检索包括PubMed、Web of Science、OVID Embase、谷歌学术和Cochrane图书馆数据库在内的数据库进行文献综述。检索时使用了以下检索标准：(((((吻合术) 或 (吻合口漏*)) 或 (术后胰瘘)) 或 (胆漏*)) 或 (胰十二指肠切除术)) 或 (惠普尔手术)) 且 ((肝胆) 或 (肝胰胆)) 且 ((定义) 或 (分级系统*) 或 (后果) 或 (结果) 或 (危险因素*) 或 (发病率) 或 (死亡率))。对检索到的出版物进行进一步评估，以确保识别并纳入其他相关出版物。
目前仍缺乏针对POPF和BL的普遍接受的定义和分级系统，导致文献报道的发病率存在差异。多个组织致力于发布POPF和BL的定义及分级指南，其中国际胰腺手术研究组（ISGPS）和国际肝脏手术研究组（ISGLS）的定义分别是目前最推荐的POPF和BL定义。从诸如发病率和死亡率增加、再次手术率升高以及再入院率增加等漏出后果的证据中可以充分证明AL给患者、医护人员和医院带来的负担。
尽管医学不断进步，但AL在HPB手术中仍然是一个重大挑战。了解在定义和分级漏出方面取得的进展以及AL产生的一系列负面结果，对于改善患者护理、降低手术死亡率以及推动AL早期检测和治疗的进一步进展至关重要。
