Mohkam et al reported a score for bile leakage after elective liver resection. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in France.
ACHBT = Association de Chirurgie Hepato-Bilio-pancreatique et de Transplantation
Patient selection: elective open or laparoscopic liver resection
Outcome: significant biliary leakage (ISGLS grade B or C)
Parameters:
(1) anatomic resection involving segment 8
(2) transection along the right aspect of the left intersectional plane
(3) estimated blood loss in mL
(4) minutes of remnant ischemia after pedicular clamping
(5) associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)
Parameter
Finding
Points
anatomic resection involving segment 8
no
0
yes
1
transection along the right aspect of the left intersectional plane
no
0
yes
1
estimated blood loss
< 500 mL
0
>= 500 mL
1
minutes of remnant ischemia
< 45 minutes
0
>= 45 minutes
1
ALPPS
no
0
yes
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 3 is associated with severe post-hepatectomy bile leak (PHBL).
Performance:
• The area under the ROC curve is 0.79 in the development cohort and 0.70 in the validation cohort.
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