Prevention of bile leak after major hepatectomy.

Background/aims: Bile leak remains a serious complication after major hepatectomy. The usefulness of external biliary drainage to prevent intraperitoneal bile leak was studied.
Methodology: Thirty-nine patients who underwent major hepatectomy from April 1997 through June 2000 were studied. The bile leak test was performed to identify and close leaks following the resection. Patients who still had leakage underwent retrograde transhepatic biliary drainage (RTBD) via a tube inserted through a choledochostomy. Patient's backgrounds, incidence of bile leak, and time until resolution of bile leak were compared between patients who did and did not have an RTBD tube placed.
Results: Nineteen patients had an RTBD tube (48.7%). Bile leak developed in 4 patients with the tube (21.1%), and in 4 patients without the tube (20.0%) (not significant). However, the time until resolution of bile leak was 13.3 days for patients with the tube and 51.3 days for patients without the tube (p<0.05). Two patients developed local peritonitis when the tube was removed.
Conclusions: Though some patients had bile leakage even with the RTBD tube, use of the RTBD tube decreased the length of time leakage that occurred. RTBD tube drainage should be done routinely with major hepatectomy.