TY - JOUR
T1 - Bile Leak Reduction with Laparoscopic Versus Open Liver Resection
T2 - A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis
AU - Smith, Alison A.
AU - Monlezun, Dominique J.
AU - Martinie, John
AU - Iannitti, David
AU - Konstantinidis, Ioannis
AU - Darden, Michael
AU - Parker, Geoffrey
AU - Fong, Yuman
AU - Buell, Joseph F.
N1 - Publisher Copyright:
© 2020, Société Internationale de Chirurgie.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Introduction: 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. Methods: 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. Results: 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. Conclusions: 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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U2 - 10.1007/s00268-019-05343-x
DO - 10.1007/s00268-019-05343-x
M3 - Article
C2 - 31897695
AN - SCOPUS:85077247019
VL - 44
SP - 1578
EP - 1585
JO - World Journal of Surgery
JF - World Journal of Surgery
SN - 0364-2313
IS - 5
ER -