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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Post-hepatectomy ascites: application of proposed definition and severity grading in 222 patients

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  • Jun Li - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Katja Kloth - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Alexandros Kantas - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Martina Koch - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Eike-Gert Achilles - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Lutz Fischer - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Bjoern Nashan - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch311

doi: 10.3205/15dgch311, urn:nbn:de:0183-15dgch3111

Published: April 24, 2015

© 2015 Li et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: There is no consensus about the definition and severity grade system on post-hepatectomy ascites (PHA). The aim of the study is to find out whether the proposed definition, severity grading system and treatment algorithms of PHA applicable.

Material and methods: Retrospective analysis of 222 patients undergoing liver resection between 07.2012 and 06.2014. The PHA was defined as postoperative intraabdominal drainage exceeding 200 ml/day after POD 3. The severity grading of PHA is proposed as the volume of PHA: Grade A PHA has less than 500 ml/day fluid. Grade B PHA has fluid between 500 ml/day and 1000 ml/day. Grade C PHA is with more than 1000 ml/day since POD 7.

Results: Among 222 patients, 86 patients (39%) developed PHA. Grade A, B, C PHA were found in 22 patients (25,6%), 40 patients (46,2%), 24 patients (28,2%) respectively. Diuretics were used in 46 patients (53,8%), 7 patients (17,9%) had additional albumin infusion. Risk factors of PHA could be prolong op time, use of Pringle manuvour over 30 min, fibrosis or cirrhosis change of liver, liver resection more than 3 segments. We found Grade C PHA developed in patients undergoing Extended right hemihepatectomy (36,4%), Extended left hemihepatectomy (9,1%), right hemihepatectomy (27,3%), atypical resection of less than 3 segments (9,1%) and trisegementectomy (18,1%).

Conclusion: The proposed definition of PHA and its severity grading is applicable. A PHA management algorithms as regarding use of diuretics and albumin as proposed need to be defined and tested in a prospective study.