The clinical risk factors associated with postoperative bile leakage after hepatectomy: a meta-analysis.

Introduction The occurrence of bile leakage (BL) is one of the major contributors to the morbidity after hepatectomy. However, the clinical risk factors associated with postoperative BL remains controversial. This study aims to further assess the risk factors for BL. Evidence acquisition We comprehensively searched the electronic databases of PubMed, EMBASE, Web of Science and the Cochrane Library for studies published before October 10th, 2015. Cohort studies, case-control studies, and randomized controlled trials that examined clinical risk factors for BL were included. Evidence synthesis Eighteen retrospective studies including a total of 9270 patients were identified. From the pooled analysis, twelve factors were found to be significantly associated to the increased rate of BL, including previous liver or biliary surgery, anatomic resection, major hepatectomy, right anterior sectionectomy, left trisectionectomy, central bisectionectomy, blood transfusion, operative time, bile duct reconstruction, segment 1 involved, segment 2 involved, segment 5 involved. By contrast, hepatic fibrosis/cirrhosis, left lateral sectionectomy were found to be correlated to decreased incidence of BL. Conclusions Our meta-analysis reveals that previous liver or biliary surgery, anatomic resection, major hepatectomy, right anterior sectionectomy, left trisectionectomy, central bisectionectomy, blood transfusion, operative time, bile duct reconstruction, resection of segments 1, 2 and 5 involved had significant positive correlation with increased risk of BL, on the contrary, hepatic fibrosis/cirrhosis, left lateral sectionectomy had the opposite effect.