Value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy

Abstract

Objective To investigate the application value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy. Methods In this prospective study, 197 patients who underwent hepatectomy alone in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2014 and November 2014 were recruited. According to the random number talbe method, the patients were divided into the hepatic portal reocclusion group (n=99) and traditional surgery group (n=98). In the hepatic portal reocclusion group, 81 cases were males and 18 females, aged (54±11) years old on average. Among them, 89 cases were diagnosed with primary liver cancer and 10 with benign liver lesions. After the liver resection with Pringle maneuver, the first porta hepatis was reoccluded to elevate the pressure of intrahepatic blie duct, and the bile duct was examined and tightly sutured. In the traditional surgery group, 82 cases were males and 16 females, aged (52±10) years old on average. Among them, 91 cases were diagnosed with primary liver cancer and 7 with benign liver lesions. The liver resection was performed using Pringle maneuver. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative status and prognosis were observed and compared between two groups. The hepatic portal occlusion time and operation time between two groups were compared using t test or Kruskal-Wallis rank test. The rates were compared using Chi-square test or Fisher's exact probability test. Results The frequency of hepatic portal occlusion in the hepatic portal reocclusion group was 2(1-4), significantly higher than 1(1-3) in the traditional surgery group (Z=0.000, P<0.05). The hepatic portal occlusion time in the hepatic portal reocclusion group was (21±10) min, significantly longer than (17±9) min in the traditional surgery group (t=0.001, P<0.05). The postoperative length of hospital stay in the hepatic portal reocclusion group was (8±3) d, significantly shorter than (9±3) d in the traditional surgery group (t=-0.040, P<0.05). The incidence of postoperative bile leakage in the hepatic portal reocclusion group was 1%(1/99), significantly lower than 9%(9/98) in the traditional surgery group (χ2=6.830, P<0.05). The symptoms of bile leakage were effectively controlled after short-term drainage. Conclusions Application of hepatic portal reocclusion can effectively reduce the incidence of bile leakage after hepatectomy, and provides a simple and efficacious approach to prevent the incidence of bile leakage for the surgeons. Key words: Hepatectomy; Biliary fistula; Hepatic portal reocclusion