Risk factors for postoperative bile leak in patients who underwent subtotal cholecystectomy
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Risk factors for postoperative bile leak in patients who underwent subtotal cholecystectomy Atsushi Kohga1 · Kenji Suzuki1 · Takuya Okumura1 · Kimihiro Yamashita1 · Jun Isogaki1 · Akihiro Kawabe1 · Taizo Kimura1 Received: 30 July 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Subtotal cholecystectomy (SC) is a procedure for avoiding the risk of bile duct injury, especially in patients with difficult gallbladders. However, recent meta-analyses have demonstrated that SC is associated with a relatively high incidence of postoperative bile leak. To our knowledge, there have been no reports that have investigated risk factors for postoperative bile leak. Methods A total of 76 patients underwent reconstituting SC at our hospital between January 2005 and July 2019. Patient characteristics and perioperative outcomes were reviewed, and risk factors for postoperative bile leak were investigated. In addition, in patients with acute cholecystitis (AC) (n = 60), subgroup analyses were performed. Results Bile leak developed in 11 patients with AC (18.3%), while no patients with chronic cholecystitis developed bile leak (p = 0.064). Patients with AC who underwent surgery 10 days or later from onset developed postoperative bile leak significantly more frequently than those who underwent surgery within 10 days (38.0 vs 7.6%, p = 0.003). Patients with AC who underwent gallbladder stump closure with suturing developed postoperative bile leak significantly more frequently than those who underwent ligation (37.5 vs 11.3%, p = 0.020). In the patients with AC, surgery after 10 days from onset (p = 0.022, odds ratio = 5.85) was found by logistic regression analysis to be an independent risk factor for developing postoperative bile leak. Conclusion Early surgery yielded a lower incidence of postoperative bile leak in patients who underwent SC. Surgery during the subacute phase was considered to imply a higher risk for developing bile leak than surgery during the acute and chronic phases. Keywords Subtotal cholecystectomy · Acute cholecystitis · Risk factor · Bile leak Bile duct injury is one of the most severe complications that occurs after cholecystectomy. Subtotal cholecystectomy (SC) is a procedure that enables surgeons to avoid bile duct injury in patients with difficult gallbladders by maintaining the neck of the gallbladder and removing the fundus of the gallbladder [1, 2]. Previous meta-analyses have demonstrated that SC results in a low incidence rate of bile duct injury; SC is associated with a relatively high incidence of postoperative bile leak [3, 4]. The purpose of this retrospective study was to investigate preoperative and intraoperative risk factors for developing postoperative bile leak in patients who underwent SC. * Atsushi Kohga [email protected] 1
Division of Surgery, Fujinomiya City General Hospital, 3‑1, Nishiki‑cho, Fujinomiya, Shizuoka 4180076, Japan
Methods Study patients Information on a
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