White test versus conventional saline test in detecting intra-operative bile leakage in liver resection

Abstract

Hepatic surgery will be always one of the most challenging surgical procedures due to its anatomical and pathophysiologic varieties. Various problems may complicate the post-operative course. Bile leak remains a serious complication after hepatectomy. Bile leaks can significantly impact morbidity, mortality, and cost of treatment. Bile leak increases risk of sepsis, need for further intervention, either radiological or return to theatre, prolongs duration of intensive care unit and hospital stay, and can precipitate liver failure and death. Intraoperative bile leak testing is proved to be decreasing post-operative bile leakage. it is done by cannulation of the cystic duct and instillation of a test substance into the biliary system with occlusion of the distal common bile duct by any means to increase pressure within the intrahepatic biliary tree, facilitating identification and control of bile leakage points on the cut liver surface by suture ligation.