The White Test: A New Dye Test for Intraoperative Detection of Bile Leakage During Major Liver Resection--Invited Critique

2008 ◽  
Vol 143 (4) ◽  
pp. 404-404 ◽  
Author(s):  
D. W. McFadden
Keyword(s):  
Liver Resection ◽  
Bile Leakage ◽  
Major Liver Resection ◽  
Intraoperative Detection ◽  
White Test

Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Ahmed Abd-Elaal Mahmoud ◽  
Hatem Sayed Saber ◽  
Mahmoud Mohamed Elsayed Ibrahim
Keyword(s):  
Liver Resection ◽  
Liver Transplant ◽  
Living Donor ◽  
Bile Leakage ◽  
Donor Liver ◽  
Partial Liver Resection ◽  
Living Donor Liver Transplant ◽  
White Test ◽  
Donor Liver Transplant ◽  
Saline Test

Abstract Background Intra-operative bile leakage testing is very important in partial liver resection in living donor liver transplant as it allows detection of bile leaking points on the cut surface and decreases postoperative bile leak which is one of the most dreadful complication following liver transplant surgery. In this study we tried to assess the Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant. Objective In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of biliary leakage in patients who will undergo partial liver resection as living donor liver transplant. Methodology In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of bile leakage in patients who underwent partial liver resection as a living donor liver transplant. This study included 60 patients who received partial liver resection as a living donor liver transplant. The conventional saline test (injecting an isotonic sodium chloride solution through the cystic duct) was carried out in 30 patients and the White test (injecting a fat emulsion solution through the cystic duct) was carried out in 30 patients Results Incidence of postoperative bile leakage was compared between the conventional method and the White test. Bile leakage occurred in 8 patients (26.7%) in the conventional method group and in 2 patients (6.7%) in the White test group. In addition, the White test detected intraoperative a significantly higher number of bile leakage sites compared with the conventional method. The White test is better than the conventional test for the intraoperative detection of bile leakage. Conclusion Based on our study, we recommend that surgeons investigating bile leakage sites during liver resections should use the White test instead of the conventional saline test.

scholarly journals The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie Chopinet ◽  
Emilie Bollon ◽  
Jean-François Hak ◽  
Laurent Reydellet ◽  
Valéry Blasco ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Liver Resection ◽  
Main Pancreatic Duct ◽  
Case Series ◽  
Bile Leakage ◽  
Pringle Maneuver ◽  
Trigger Factor ◽  
Extended Lymphadenectomy ◽  
White Test ◽  
Potential Trigger

Abstract Background Acute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear. Cases presentation We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis. Conclusion The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct.

scholarly journals Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk?

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexander Fischer ◽  
Juri Fuchs ◽  
Christos Stravodimos ◽  
Ulf Hinz ◽  
Adrian Billeter ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Liver Resection ◽  
Bile Leakage ◽  
Unplanned Readmission ◽  
Safe Procedure ◽  
Major Liver Resection ◽  
Short Term ◽  
Operative Outcome

Abstract Background Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection. Methods Four hundred seventeen major liver resections (≥ 3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m2 and < 30 kg/m2 and obesity as BMI ≥ 30 kg/m2. Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien–Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively. Results Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien–Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

scholarly journals Diagnostic role of the ‘white test’ with lipidic solution in the early intraoperative identification of open bile ducts for the prevention of bile leakage after liver resection: study protocol for a randomised controlled multicentric superiority trial (BiLe-Trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049449
Author(s):  
Alessandra Cristaudi ◽  
Ignazio Tarantino ◽  
Andreas Scheiwiller ◽  
Andrea Wiencierz ◽  
Pietro Majno-Hurst ◽  
...  
Keyword(s):  
Side Effects ◽  
Liver Resection ◽  
Bile Ducts ◽  
Group Identification ◽  
Bile Leakage ◽  
Leakage Rate ◽  
Superiority Trial ◽  
White Test ◽  
Randomised Controlled ◽  
Interventional Drainage

IntroductionBile leakage is a frequent complication after liver resection associated with the need of interventional drainage, endoscopic retrograde cholangio pancreatography (ERCP) or reoperation. The intraoperative application of the white test could be a promising strategy to reduce the occurrence of bile leakages. Therefore, we propose to conduct the first multicentric randomised controlled trial with rate of postoperative bile leakage as primary endpoint with and without the white test.Methods and analysisThe Bile-Leakage Trial trial is an investigator-initiated randomised controlled, parallel group, double-blinded, multicentric, superiority trial in four Swiss centres. A total of 210 patients undergoing a resection of at least 2 liver segments will be randomly allocated intraoperatively to either the intervention (identification of open bile ducts with administration of 20–40 mL SMOFlipid5% in the bile tract) or the control group (identification with a white gauze on the liver resection surface).Primary outcome will be the comparison of the postoperative bile leakage rate in both groups within 30 days after liver resection, defined according to the classification of the International Study Group of Liver Surgery. Secondary outcomes will be operative and postoperative complication, including severity grade of the bile leakage, rate of ERCP, interventional drainage, morbidity, intensive care unit stay, and mortality.Ethics and disseminationThe cantonal ethics committees of all participating centres and Swissmedic approved the study. SMOFlipid20% consists of a mixture of oils, no side effects resulting from the intraoperative application of 20–40 mL in the biliary tract with consecutive enteral absorption are expected nor are side effects described in the literature. SMOFlipid20% will be diluted intraoperatively with isotonic saline solution to a concentration of 5%. The results of the BiLe-Trial will be submitted to a peer-reviewed journal regardless of the outcome. As this is an investigator-initiated trial, data are property of the sponsor investigator and can be obtained on request.Trial registration numberClinicaltrials.gov, ID: NCT04523701. Registered on 25 August 2020.Swiss National Clinical Trials Portal (SNCTP), ID: SNCTP000004200. Registered on 20 January 2021.Protocol versionV3.2_14-12-2020_clean.pdf

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

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham Hasan Wagdi ◽  
Ahmed Khalil ◽  
Hatem Sayed Saber ◽  
Karim Mohamed Gamal Elden
Keyword(s):  
Liver Resection ◽  
Bile Leak ◽  
Bile Leakage ◽  
University Hospitals ◽  
Cost Of Treatment ◽  
White Test ◽  
A Prospective Study ◽  
Surgery Department ◽  
Saline Test ◽  
Bile Leaks

Abstract Background 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. Objective To assess the post-operative bile leak complication after using white test versus conventional saline test Patients and Methods A prospective study on 50 Hepatectomy cases divided into two groups, the first group consist of 25 cases using white test and the second group consist of 25 cases using conventional saline test from January 2019 to January 2020, at Hepatobiliary unit of the general surgery department of Ain Shams university hospitals. Results The White test has clear advantages in comparison with other bile leakage tests: it precisely detects bile leakages, regardless of size; it does not stain the resection surface, allowing it to be washed off and repeated ad infinitum; and it is safe, quick, and inexpensive. The white test is a feasible and sensitive bile leakage test with no obvious disadvantages. It could be a possible standardized method to prevent bile leakage in major liver resection. Conclusion Now after we discussed our study and reviewed other opinions discussing the optimal methods for intraoperative bile leakage testing, we have now settled on White test using fat emulsion solution to be best of all tests.

scholarly journals Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

2020 ◽  
Author(s):  
Alexander Fischer ◽  
Juri Fuchs ◽  
Christos Stravodimos ◽  
Ulf Hinz ◽  
Adrian Billeter ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Liver Resection ◽  
Bile Leakage ◽  
Unplanned Readmission ◽  
Safe Procedure ◽  
Major Liver Resection ◽  
Short Term ◽  
Operative Outcome

Abstract Background: Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection. Methods: Four hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m 2 and < 30 kg/m 2 and obesity as BMI ≥ 30 kg/m 2 . Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively. Results: Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions: Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

scholarly journals Case Report: Successful DaVinci-Assisted Major Liver Resection for Alveolar Echinococcosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Mohammad Golriz ◽  
Viktoria Flossmann ◽  
Ali Ramouz ◽  
Ali Majlesara ◽  
Yakup Kulu ◽  
...  
Keyword(s):  
Liver Resection ◽  
Alveolar Echinococcosis ◽  
Fluid Collection ◽  
Bile Leakage ◽  
Radical Resection ◽  
Major Liver Resection ◽  
Curative Therapy ◽  
The Right ◽  
Surgical System ◽  
Radical Surgical Resection

We report a case of successful robot-assisted major liver resection in a patient with liver alveolar echinococcosis (AE). A 62-year-old male patient was incidentally diagnosed with a large infiltrative lesion in the right liver lobe suspicious for AE. A radical surgical resection as a right-sided hemihepatectomy was indicated. The operation was carried out via a robotic-assisted procedure using the DaVinci Xi Surgical System. The tumor measured 12.4 × 8.8 cm and was successfully resected through a suprapubic incision of 13 cm. The patient was free of pain after the second post-operative day. A fluid collection near the resection plate was easily drained without bile leakage. The patient had no surgical complications. Radical resection is inevitable for adequate curative therapy of AE and provides clear margins. Robotic surgery is a relatively new and safe option for curative resection of AE lesions, with remarkable advantages for patients and surgeons.

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