A novel algorithm for the diagnosis and treatment of different types of bile leakage following hepatectomy with bilioenteric anastomosis

Introduction: After liver resection with bilioenteric anastomosis (BEA), post-hepatectomy bile leakage (PHBL) may originate from two main sources: the BEA or the transection surface of the liver. Leaks from the transection surface can result from either isolated bile ducts not connected to the central biliary tree or from small intrahepatic ducts inadequately closed during parenchymal dissection. Accurate localization remains challenging, as current diagnostic methods are complex and often inconclusive. Consequently, standardized guidelines for PHBL diagnosis and management are still lacking.