Background Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome. Methods The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined. Results Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications. Conclusions Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.

Clemente, G., De Rose, A. M., Murri, R., Ardito, F., Nuzzo, G., Giuliante, F., Liver resection for primary intrahepatic stones: Focus on postoperative infectious complications, <<WORLD JOURNAL OF SURGERY>>, 2016; 40 (2): 433-439. [doi:10.1007/s00268-015-3227-x] [http://hdl.handle.net/10807/78193]

Liver resection for primary intrahepatic stones: Focus on postoperative infectious complications

Clemente, Gennaro
Primo
;
De Rose, Agostino Maria
Secondo
;
Murri, Rita;Ardito, Francesco;Nuzzo, Gennaro
Penultimo
;
Giuliante, Felice
Ultimo
2016

Abstract

Background Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome. Methods The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined. Results Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications. Conclusions Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.
Inglese
Clemente, G., De Rose, A. M., Murri, R., Ardito, F., Nuzzo, G., Giuliante, F., Liver resection for primary intrahepatic stones: Focus on postoperative infectious complications, <<WORLD JOURNAL OF SURGERY>>, 2016; 40 (2): 433-439. [doi:10.1007/s00268-015-3227-x] [http://hdl.handle.net/10807/78193]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/78193
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