The reported rate of postoperative bile leak is variable between 3 and 33%. Recent data would suggest a minimally invasive approach to liver surgery has decreased this incidence.
This multi-institutional case–control study utilized databases from three high-volume surgeons. All consecutive open and minimally invasive liver resection cases were analyzed in a propensity score-adjusted multivariable regression. A p value < 0.05 was considered significant.
In 1388 consecutive liver resections, the average age was 56.9 ± 14.0 years, 730 (52.59%) were male gender, and 599 (43.16%) underwent minimally invasive liver resection. Thirty-nine (2.81%) in the series were identified with post-resection bile duct leaks. Leaks were associated with major resections and increased blood loss (p < 0.05). Propensity score-adjusted multivariable regression identified minimally invasive liver resection significantly and independently reduced the odds of bile duct leak (OR 0.48, p = 0.046) even controlling for BMI, ASA, cirrhosis, major resection, and resection year.
Our data suggest the incidence of bile leaks in a large-volume center series is far less than previously reported and that a minimally invasive approach to liver resection reduces the incidence of postoperative bile leak.
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Conflict of interest
Dr. Buell, Iannitti, and Fong are paid consultants to Ethicon and Medtronic for work that is outside the scope of this manuscript. Dr. Martinie is a paid consultant to Intuitive Surgical, Ethicon and Medtronic for work that is outside the scope of this manuscript. Drs. Smith, Monlezun, Konstantinidis, Parker, and Darden have no disclosure or financial ties to disclose.
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Smith, A.A., Monlezun, D.J., Martinie, J. et al. Bile Leak Reduction with Laparoscopic Versus Open Liver Resection: A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis. World J Surg (2020) doi:10.1007/s00268-019-05343-x