• Burak Görgec, CacciaguerraAndrea BenedettiABFrom the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal).Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK (Görgec, Cacciag, Luca A Aldrighetti, Alessandro Ferrero, Umberto Cillo, Bjørn Edwin, Marco Vivarelli, Santiago Lopez-Ben, Marc G Besselink, Mohammed Abu Hilal, and International Study Group of Bile Leakage after Liver Surgery.
• From the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal).
• J. Am. Coll. Surg. 2022 Feb 1; 234 (2): 9911299-112.

BackgroundDespite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver resection (OLR). This study aimed to assess the incidence and clinical impact of POBL in patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score-matched analysis.Study DesignPatients undergoing LLR or OLR for all indications between January 2000 and October 2019 were retrospectively analyzed using a large, international, multicenter liver database including data from 15 tertiary referral centers. Primary outcome was clinically relevant POBL (CR-POBL), defined as Grade B/C POBL.ResultsOverall, 13,379 patients met the inclusion criteria and were included in the analysis (6,369 LLR and 7,010 OLR), with 6.0% POBL. After propensity score matching, a total of 3,563 LLR patients were matched to 3,563 OLR patients. In both groups, propensity score matching accounted for similar extent and types of resections. The incidence of CR-POBL was significantly lower in patients after LLR as compared with patients after OLR (2.6% vs 6.0%; p < 0.001). Among the subgroup of patients with CR-POBL, patients after LLR experienced less severe (non-POBL) postoperative complications (10.1% vs 20.9%; p = 0.028), a shorter hospital stay (12.5 vs 17 days; p = 0.001), and a lower 90-day/in-hospital mortality (0% vs 5.4%; p = 0.027) as compared with patients after OLR with CR-POBL.ConclusionPatients after LLR seem to experience a lower rate of CR-POBL as compared with the open approach. Our findings suggest that in patients after LLR, the clinical impact of CR-POBL is less than after OLR.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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