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Background <p>Left-sided hepatectomy is a&#xa0;primary treatment for hepatolithiasis, yet postoperative bile leakage remains a&#xa0;major concern. This study aimed to investigate the risk factors, management, and postoperative impact of bile leakage following left-sided hepatectomy for hepatolithiasis.</p> Methods <p>We retrospectively analyzed 515 consecutive patients undergoing left-sided hepatectomy for hepatolithiasis (2015–2024). The impacts of recent cholangitis and concomitant bile duct exploration on bile leakage rates were evaluated. Management strategies and postoperative outcomes were compared between patients with and without bile leakage.</p> Results <p>The incidence of bile leakage was 5.0% (26/515). Multivariate analysis identified cholangitis within 1&#xa0;month prior to surgery as an independent risk factor (<i>P</i> &lt; 0.001). In patients with recent cholangitis, concomitant bile duct exploration with T‑tube placement significantly reduced the bile leakage rate (16.1% vs. 50.0%; <i>P</i> = 0.029). A&#xa0;step-up management approach was highly effective: bile leakage resolved with intraoperative drains alone in 19&#xa0;patients (73.1%), whereas refractory cases were successfully managed with percutaneous drainage, endoscopic biliary drainage, or reoperation. Bile leakage was associated with significantly higher rates of infectious complications (30.8% vs.&#xa0;7.2%; <i>P</i> &lt; 0.001), major complications (34.6% vs.&#xa0;2.2%; <i>P</i> &lt; 0.001), and a&#xa0;prolonged postoperative hospital stay (<i>P</i> &lt; 0.001).</p> Conclusion <p>Recent cholangitis is a&#xa0;significant risk factor for bile leakage. Concomitant bile duct exploration with T‑tube placement may mitigate this risk in patients with recent cholangitis. Conservative management with intraperitoneal drainage is effective in most cases. Bile leakage substantially worsens postoperative outcomes, increasing major morbidity and prolonging hospitalization.</p>

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Risk factors, management, and postoperative impact of bile leakage after left-sided hepatectomy for hepatolithiasis

  • 期刊论文

  • 发表日期：

    2026年1月22日

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  • Zhen Wan,
  • Lei Wu,
  • Xuzhen Wang

摘要

Background

Left-sided hepatectomy is a primary treatment for hepatolithiasis, yet postoperative bile leakage remains a major concern. This study aimed to investigate the risk factors, management, and postoperative impact of bile leakage following left-sided hepatectomy for hepatolithiasis.

Methods

We retrospectively analyzed 515 consecutive patients undergoing left-sided hepatectomy for hepatolithiasis (2015–2024). The impacts of recent cholangitis and concomitant bile duct exploration on bile leakage rates were evaluated. Management strategies and postoperative outcomes were compared between patients with and without bile leakage.

Results

The incidence of bile leakage was 5.0% (26/515). Multivariate analysis identified cholangitis within 1 month prior to surgery as an independent risk factor (P < 0.001). In patients with recent cholangitis, concomitant bile duct exploration with T‑tube placement significantly reduced the bile leakage rate (16.1% vs. 50.0%; P = 0.029). A step-up management approach was highly effective: bile leakage resolved with intraoperative drains alone in 19 patients (73.1%), whereas refractory cases were successfully managed with percutaneous drainage, endoscopic biliary drainage, or reoperation. Bile leakage was associated with significantly higher rates of infectious complications (30.8% vs. 7.2%; P < 0.001), major complications (34.6% vs. 2.2%; P < 0.001), and a prolonged postoperative hospital stay (P < 0.001).

Conclusion

Recent cholangitis is a significant risk factor for bile leakage. Concomitant bile duct exploration with T‑tube placement may mitigate this risk in patients with recent cholangitis. Conservative management with intraperitoneal drainage is effective in most cases. Bile leakage substantially worsens postoperative outcomes, increasing major morbidity and prolonging hospitalization.