Risk factors and outcomes of bile leak after laparoscopic surgery for congenital biliary dilatation

• Published in: Pediatric surgery international Vol. 37; no. 2; pp. 235 - 240
• Main Authors: Tanaka, Yujiro, Tainaka, Takahisa, Hinoki, Akinari, Shirota, Chiyoe, Sumida, Wataru, Yokota, Kazuki, Oshima, Kazuo, Makita, Satoshi, Amano, Hizuru, Takimoto, Aitaro, Kano, Yoko, Uchida, Hiroo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2021; Springer Nature B.V
• Subjects: Endoscopy; Laparoscopy; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Risk factors; Surgeons; Surgery; Congenital biliary dilatation; Laparoscopic surgery; Bile leak; Early complication
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-020-04791-0

Purpose
One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery.
Methods
We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak.
Results
Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (
P
 = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (
P
 = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards.
Conclusion
Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.