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Location of a biliary leak after liver resection determines success of endoscopic treatment

Anja Schaible, Peter Schemmer, Thilo Hackert, Christian Rupp, Anna E. Schulze Schleithoff, Daniel N. Gotthardt, Markus W. Büchler, Peter Sauer

Background: Bile leaks after hepatic resection are serious complications associated with substantial morbidity and mortality. The aim of this prospective observational study was to determine the therapeutic success of endoscopic treatment of biliary leakage after liver resection. Patients and method... Full description

Main Author: Schaible, Anja
Contributors: Schemmer, Peter | Author
Hackert, Thilo | Author
Rupp, Christian | Author
Schulze-Schleithoff, Anna | Author
Gotthardt, Daniel | Author
Büchler, Markus W. | Author
Sauer, Peter | Author
Published: 17 August 2016
Contained in: Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 31(2017), 4, Seite 1814-1820
Journal Title: Surgical endoscopy and other interventional techniques
Fulltext access:
Availability is being checked...
Links: Volltext (dx.doi.org)
ISSN: 1432-2218
Keywords: Biliary leak
ERCP
Endoscopic treatment
Hepatic resection
Outcome
DOI: 10.1007/s00464-016-5178-1
Regional Holdings: TIB – German National Library of Science and Technology
Physikalisch-Technische Bundesanstalt
Language: English
Notes: Gesehen am 04.10.2016
Physical Description: 7
ID (e.g. DOI, URN): 10.1007/s00464-016-5178-1
PPN (Catalogue-ID): 1571831657
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520 |a Background: Bile leaks after hepatic resection are serious complications associated with substantial morbidity and mortality. The aim of this prospective observational study was to determine the therapeutic success of endoscopic treatment of biliary leakage after liver resection. Patients and methods: Grade B biliary leaks were considered for endoscopic treatment in patients after liver resection between 1/09 and 4/12. Endoscopic treatment (sphincterotomy only, plastic stent distal to leak or bridging) was defined as successful when the patient remained without symptoms after drain removal and without extravasation follow-up ERC 8 weeks later. Results: Overall rate of biliary leak was 7.4 % (61/826). 35 patients with a grade B bile leak were considered for endoscopic treatment. 22 (63 %) had bile leaks that were peripherally located, and 13 (37 %) had bile leaks at central location. In 3 patients, sphincterotomy only was performed; in 19 patients, a stent distal to the leak and in 13 patients, a bridging stent was inserted. The overall success rate was 74 % (26/35 patients). Endoscopic treatment failed in 26 % (9/35), and mortality rate was 11 % (4/35). In all patients with leaks located at the right or left hepatic duct, treatment with the bridging stent was successful. Conclusion: Endoscopic therapy for biliary leakage after liver resection is safe and effective and should be considered as a first-line therapy in patients who are suitable for an interventional, non-surgical approach. Patients with a centrally located leak who are treated with a bridging stent are more likely to benefit from endoscopic intervention. 
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