Synapse - Symptomatic perihepatic fluid collections after hepatic resection in the modern era

Symptomatic perihepatic fluid collections after hepatic resection in the modern era Journal Article

Authors:	Konstantinidis, I. T.; Mastrodomenico, P.; Sofocleous, C. T.; Brown, K. T.; Getrajdman, G. I.; Gönen, M.; Allen, P. J.; Kingham, T. P.; DeMatteo, R. P.; Fong, Y.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title:	Symptomatic perihepatic fluid collections after hepatic resection in the modern era
Abstract:	e Improvements in liver surgery have led to decreased mortality rates. Symptomatic perihepatic collections (SPHCs) requiring percutaneous drainage remain a significant source of morbidity. A single institution's prospectively maintained hepatic resection database was reviewed to identify patients who underwent hepatectomy between January 2004 and February 2012. Data from 2173 hepatectomies performed in 2040 patients were reviewed. Overall, 200 (9 %) patients developed an SPHC, the majority non-bilious (75.5 %) and infected (54 %). Major hepatic resections, larger than median blood loss (a parts per thousand yen360 ml), use of surgical drains, and simultaneous performance of a colorectal procedure were associated with an SPHC on multivariate analysis. Non-bilious, non-infcted (NBNI) collections were associated with lower white blood cell (WBC) counts, absence of a bilio-enteric anastomosis, use of hepatic arterial infusion pump (HAIP), and presence of metastatic disease, and resolved more frequently with a single interventional radiology (IR) procedure (85 vs 46.5 %, p < 0.001) more quickly (15 vs 30 days, p = 0.001). SPHCs developed in 9 % of patients in a modern series of hepatic resections, and in one third were non-bilious and non-infected. In the era of modern interventional radiology, the need for re-operation for SPHC is exceedingly rare. A significant proportion of minimally symptomatic SPHC patients may not require drainage, and strategies to avoid unnecessary drainage are warranted.
Keywords:	mortality; bile leakage; liver resection; hepatectomy; malignancy; management; drainage; hepatic resection; hepatocellular-carcinoma; abdominal; randomized clinical-trial; symptomatic perihepatic fluid collections; non-bilious; non-infected collections; interventional radiology drainage; transection
Journal Title:	Journal of Gastrointestinal Surgery
Volume:	20
Issue:	4
ISSN:	1091-255X
Publisher:	Springer
Date Published:	2016-04-01
Start Page:	748
End Page:	756
Language:	English
ACCESSION:	WOS:000373158700012
DOI:	10.1007/s11605-015-3041-7
PROVIDER:	wos
PMCID:	PMC4830382
PUBMED:	26643300
Notes:	Article; Proceedings Paper -- Previously presented at the Meeting of the American College of Surgeons on Sep 28, 2014 in San Francisco, CA -- Source: Wos