Abstract
Introduction: Hepaticoenterostomy is an important step in hepatopancreatobiliary (HPB) surgery with a subsequent bile leakage (BL) rate of up to 5%. The International Study Group of Liver Surgery (ISGLS) proposed a grading system for BL after HPB surgery. This study aimed to validate this grading system for BL in pancreatic surgery (PS) and to investigate the postoperative outcomes of BL after PS. Methods: Data were extracted for any type of pancreatectomy with hepaticoenterostomy between 2006 and 2019. The BL was graded according to the ISGLS classification. The influence of our standardized hepaticoenterostomy technique and the complexity of the surgery on BL rate were assessed in different time frames. Results: BL was detected in 156 of 5,300 patients (2.9%, Table 1). During the study period, the overall rate of Type-B and C BL showed a slight reduction from 3.5% to 2.4%. Patients with Type-C BL had higher wound infection rate and longer ICU-stay. Patients with Type-C BL receiving late surgical revision (>5th day postoperative) had higher mortality rate compared to patients with Type-B and early Type-C BL (Table 2). Conclusion: The ISGLS classification is valid for classifying BL after PS. The BL rate is influenced by the complexity of surgery (Figure 1). Patients with early Type-C BL who undergo reoperation in the first five days have better outcomes than late onset Type-C BL patients. Although rare, BL following PS is a severe complication with a major impact on patient outcome contributing significantly to morbidity and mortality.Tabled 1EP02D-052Grade B(n= 70)Early grade C+(n= 39)Late grade C‡(n= 43)P-valuen (%) or median (range)Wound infection10 (14.3%)14 (35.9%)21 (48.9%)< 0.001Intervention (CT-guided drainage and/or PTCD)70 (100%)20 (51.3%)24 (55.8%)0.001Re-intubation14 (20%)12 (30.8%)16 (37.2%)0.16ICU stay (days)7 (0–76)10 (0–131)18 (2–173)<0.001*Hospital stay (days)40.5 (15–109)35 (9–182)43 (14–235)0.22∗30-day mortality9 (12.9%)7 (17.9%)14 (32.6 %)0.0390-day mortality13 (18.6%)9 (23.1%)16 (37.2%)0.08 Open table in a new tab
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