%0 Journal Article
%T Evaluation of the White Test for the Intraoperative Detection of Bile Leakage
%A Kawin Leelawat
%A Kittipong Chaiyabutr
%A Somboon Subwongcharoen
%A Sa-ad Treepongkaruna
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/425435
%X We assess whether the White test is better than the conventional bile leakage test for the intraoperative detection of bile leakage in hepatectomized patients. This study included 30 patients who received elective liver resection. Both the conventional bile leakage test (injecting an isotonic sodium chloride solution through the cystic duct) and the White test (injecting a fat emulsion solution through the cystic duct) were carried out in the same patients. The detection of bile leakage was compared between the conventional method and the White test. A bile leak was demonstrated in 8 patients (26.7%) by the conventional method and in 19 patients (63.3%) by the White test. In addition, the White test detected a significantly higher number of bile leakage sites compared with the conventional method (Wilcoxon signed-rank test; ). The White test is better than the conventional test for the intraoperative detection of bile leakage. Based on our study, we recommend that surgeons investigating bile leakage sites during liver resections should use the White test instead of the conventional bile leakage test. 1. Introduction Postoperative bile leakage is one of the most common causes of sepsis and liver failure after liver surgery [1, 2]. Previous studies demonstrated that the incidence of postoperative bile leakage after liver surgery ranges from 3 to 27% [2¨C5]. The conventional intraoperative bile leakage test, which involves injecting an isotonic sodium chloride solution through the cystic duct, has been used to detect leakage from the transected liver surface [6]. One of the major problems in using the conventional bile leakage test is that the isotonic sodium chloride solution is a transparent solution. Therefore, it is difficult to detect the point of bile leakage. A previous randomized study indicated that there is no advantage to using the isotonic sodium chloride solution for the bile leakage test during liver resection [6]. Recently, intraoperative application of the White test has been demonstrated to reduce the incidence of postoperative bile leakage [7, 8]. In this technique, bile leakage sites on the transected liver surface are identified by injecting a fat emulsion solution through the cystic duct. The previous prospective observational studies suggested that the fat emulsion solution used in the White test is easily recognized, innocuous to the tissues, and can be easily removed without misleading tissue staining [7, 8]. Therefore, we executed a prospective study to assess whether the White test is better than the conventional bile leakage test
%U http://www.hindawi.com/journals/hpb/2012/425435/