Risk factors and impact on bile leakage in patients with choledochal cysts: a retrospective case–control analysis
Tóm tắt
Although bile leakage is a major postoperative complication after hepatobiliary surgery, the associated risk factors for pediatric patients remain poorly defined. Here, we intend to identify the perioperative risk factors for bile leakage in pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy. A multicenter case–control study investigating the risk factors for bile leakage was conducted among 1179 eligible pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy between January 2009 and December 2019. There were 267 cases with bile leakage, and approximately four control patients were identified for each case. Multivariable logistic regression was performed to identify the risk factors, including perioperative variables. According to univariable analysis, bile leakage was associated with severe cholangitis (p = 0.012), low albumin levels (p = 0.010), anemia (p = 0.002) and laparoscopic surgery (p = 0.004). Multivariable analysis showed that a low level of preoperative albumin (ALB) (odds ratio [OR] = 1.11; 95% CI 1.02–1.19; p = 0.016), worse symptoms (severe cholangitis) (OR = 1.16; 95% CI 1.01–1.26; p < 0.001), and a previous hepatobiliary procedure (OR = 1.32; 95% CI 1.09–1.63; p = 0.036) were independent factors that were associated with bile leakage. This study identified potential risk factors for bile leakage in patients following Roux-en-Y hepaticojejunostomy that should be targeted for interventions to reduce the occurrence of the condition.
Tài liệu tham khảo
Sheng Q, Lv Z, Xu W, Xiao X, Liu J, Wu Y (2017) Reoperation after cyst excision with hepaticojejunostomy for choledochal cysts: our experience in 18 cases. Med Sci Monit 20(23):1371–1377
Ronnekleiv-Kelly SM, Soares KC, Ejaz A, Pawlik TM (2016) Management of choledochal cysts. Curr Opin Gastroenterol 32(3):225–231
Moslim MA, Takahashi H, Seifarth FG, Walsh RM, Morris-Stiff G (2016) Choledochal cyst disease in a western center: a 30-year experience. J Gastrointest Surg 20(8):1453–1463
Gadelhak N, Shehta A, Hamed H (2014) Diagnosis and management of choledochal cyst: 20 years of single center experience. World J Gastroenterol 20(22):7061–7066
Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM (2017) Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 33(6):637–650
Zhang B, Wu D, Fang Y, Bai J, Huang W, Liu M, Chen J, Li L (2019) Early complications after laparoscopic resection of choledochal cyst. Pediatr Surg Int 35(8):845–852
Han JH, Lee JH, Hwang DW, Song KB, Shin SH, Kwon JW, Lee YJ, Kim SC, Park KM (2018) Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches. Ann Hepatobiliary Pancreat Surg 22(4):359–366
Chen J, Jiang B, Yi J, Huang L, Si X (2017) Modified biliary-enteric anastomosis for congenital choledochal cyst: clinical and prognostic analysis of 91 cases. Pediatr Surg Int 33(6):721–726
Ngoc Son T, Thanh Liem N, Manh HV (2014) One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases. Pediatr Surg Int 30(3):287–290
Diao M, Li L, Cheng W (2018) Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts. Surg Endosc 32(7):3402–3409
Tang ST, Yang Y, Wang Y, Mao YZ, Li SW, Tong QS, Cao GQ, Zhao ZX (2011) Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases. Surg Endosc 25(2):416–422
Diao M, Li L, Cheng W (2016) Laparoscopic redo hepaticojejunostomy for children with choledochal cysts. Surg Endosc 30(12):5513–5519
Cauchy F, Fuks D, Nomi T, Schwarz L, Belgaumkar A, Scatton O, Soubrane O, Gayet B (2016) Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy. Surg Endosc 30(9):3709–3719
Guillaud A, Pery C, Campillo B, Lourdais A, Sulpice L, Boudjema K (2013) Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB (Oxford) 15(3):224–229
Ishii H, Ochiai T, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Kokuba Y, Sonoyama T, Otsuji E (2011) Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis. Dig Surg 28(3):198–204
Ou D, Yang H, Zeng Z, Luo Y, Yang L (2016) Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma. Dig Liver Dis 48(8):934–939
Li SQ, Liang LJ, Peng BG, Lu MD, Lai JM, Li DM (2007) Bile leakage after hepatectomy for hepatolithiasis: risk factors and management. Surgery 141(3):340–345
Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Stukenborg GJ, Zaydfudim VM (2018) Clinical factors and postoperative impact of bile leak after liver resection. J Gastrointest Surg 22(4):661–667
Attasaranya S, Fogel EL, Lehman GA (2008) Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin N Am 92(4):925–960
Zafar SN, Khan MR, Raza R, Khan MN, Kasi M, Rafiq A, Jamy OH (2011) Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg 25(11):19
Rasslan R, Utiyama EM, Marques GM et al (2014) Inflammatory activity modulation by hypertonic saline and pentoxifylline in a rat model of strangulated closed loop small bowel obstruction. Int J Surg 12:594–600
Vincent JL, De Backer D, Wiedermann CJ (2016) Fluid management in sepsis: the potential beneficial effects of albumin. J Crit Care 35:161–167