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% [2–5]. 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
References
[1]
Y. I. Yamashita, T. Hamatsu, T. Rikimaru et al., “Bile leakage after hepatic resection,” Annals of Surgery, vol. 233, no. 1, pp. 45–50, 2001.
[2]
D. Langer, M. Ryska, F. Belina et al., “Biliary complications after major liver resection,” Rozhledy v Chirurgii, vol. 90, no. 3, pp. 152–155, 2011.
[3]
D. Erdogan, O. R. C. Busch, O. M. Van Delden, E. A. J. Rauws, D. J. Gouma, and T. M. Van Gulik, “Incidence and management of bile leakage after partial liver resection,” Digestive Surgery, vol. 25, no. 1, pp. 60–66, 2008.
[4]
H. Ishii, T. Ochiai, Y. Murayama et al., “Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis,” Digestive Surgery, vol. 28, no. 3, pp. 198–204, 2011.
[5]
H. Nakayama, H. Masuda, M. Shibata, S. Amano, and M. Fukuzawa, “Incidence of bile leakage after three types of hepatic parenchymal transection,” Hepato-Gastroenterology, vol. 50, no. 53, pp. 1517–1520, 2003.
[6]
M. Ijichi, T. Tahayama, H. Toyoda, K. Sano, K. Kubota, and M. Makuuchi, “Randomized trial of the usefulness of a bile leakage test during hepatic resection,” Archives of Surgery, vol. 135, no. 12, pp. 1395–1400, 2000.
[7]
J. Li, M. Malagó, G. C. Sotiropoulos et al., “Intraoperative application of "white test" to reduce postoperative bile leak after major liver resection: results of a prospective cohort study in 137 patients,” Langenbeck's Archives of Surgery, vol. 394, no. 6, pp. 1019–1024, 2009.
[8]
S. Nadalin, J. Li, H. Lang et al., “The white test: a new dye test for intraoperative detection of bile leakage during major liver resection,” Archives of Surgery, vol. 143, no. 4, pp. 402–404, 2008.
[9]
M. Arru, C. Pulitanò, L. Aldrighetti, M. Catena, R. Finazzi, and G. Ferla, “A prospective evaluation of ultrasonic dissector plus harmonic scalpel in liver resection,” American Surgeon, vol. 73, no. 3, pp. 256–260, 2007.
[10]
K. S. Gurusamy, H. Sheth, Y. Kumar, D. Sharma, and B. R. Davidson, “Methods of vascular occlusion for elective liver resections,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD007632, 2009.
[11]
M. Koch, O. J. Garden, R. Padbury et al., “Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery,” Surgery, vol. 149, no. 5, pp. 680–688, 2011.
[12]
T. Sakaguchi, A. Suzuki, N. Unno et al., “Bile leak test by indocyanine green fluorescence images after hepatectomy,” American Journal of Surgery, vol. 200, no. 1, pp. e19–e23, 2010.
[13]
M. Kaibori, M. Ishizaki, K. Matsui, and A. Hon Kwon, “Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection,” Surgery, vol. 150, no. 1, pp. 91–98, 2011.
[14]
G. Morris-Stiff, S. Farid, and K. R. Prasad, “The white test: a real benefit?” Archives of Surgery, vol. 144, no. 2, pp. 196–197, 2009.
[15]
L. Capussotti, A. Ferrero, L. Viganò, E. Sgotto, A. Muratore, and R. Polastri, “Bile leakage and liver resection: where is the risk?” Archives of Surgery, vol. 141, no. 7, pp. 690–694, 2006.
[16]
D. Dahiya, T. J. Wu, C. F. Lee, K. M. Chan, W. C. Lee, and M. F. Chen, “Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: a 20-year experience,” Surgery, vol. 147, no. 5, pp. 676–685, 2010.
