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.

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 Post burn neck contracture: an algorithm for choosing the ideal surgical method of management

2020 ◽  
Vol 7 (2) ◽  
pp. 547
Author(s):  
Medhat S. Hassan
Keyword(s):  
Surgical Technique ◽  
Anatomical Location ◽  
Surgical Results ◽  
University Hospitals ◽  
Great Satisfaction ◽  
Severe Impairment ◽  
A Prospective Study ◽  
Surgery Department ◽  
Ideal Method ◽  
The Ideal

Background: The aim of the study is to facilitate choosing the surgical technique that will be suitable for improving both function and aesthetics of each patient through this suggested algorithm system.  Any post burn neck contracture usually causes severe impairment of function and aesthetics, which causes serous psychological and social problems. That’s why it is very important to sub-categorize this type of deformity by anatomical location and cause of burn to allow choosing the ideal method of surgical management.Methods: This is a prospective study which was performed in Plastic Surgery Department, Menoufia University Hospitals over the period from March 2017 to March 2019. The study included 30 patients suffering post burn neck contracture deformities.Results: Patients were carefully examined, and the post burn neck deformities were analyzed according to age, condition of skin at the contracture site, the range of sternomastoid muscles movement at both sides of the neck and patient's general condition. Patients were given scores and categorized into 4 grades. And according to each patient's grade, the suitable surgical technique was chosen and fulfilled. 25 patients showed great satisfaction to their post operative’s outcomes and the rest were poorly satisfied.Conclusions: Application of patients with post burn neck contractures to this algorithm system will make it easy to choose the ideal method of management and gain the best surgical results possible when performing surgical correction.

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.

A Prospective Study of Bile Leaks after Laparoscopic Cholecystectomy for Acute Cholecystitis

2006 ◽  
Vol 72 (3) ◽  
pp. 265-268 ◽  
Author(s):  
Edward P. Dominguez ◽  
Dave Giammar ◽  
John Baumert ◽  
Oscar Ruiz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Prospective Study ◽  
Acute Cholecystitis ◽  
Effective Treatment ◽  
Open Cholecystectomy ◽  
Bile Leak ◽  
Elective Setting ◽  
A Prospective Study ◽  
Bile Leaks

Surgeons are increasingly performing laparoscopic cholecystectomy in the setting of acute cholecystitis. The acutely inflamed gallbladder poses a more technically demanding dissection with potential for an increase in bile leak rates. Clinical and subclinical bile leak rates after laparoscopic and open cholecystectomy in the elective setting are known. This study prospectively evaluates the rate of clinical and subclinical bile leaks after laparoscopic cholecystectomy in the setting of acute cholecystitis. One hundred patients underwent laparoscopic cholecystectomy for acute cholecystitis, as determined intraoperatively and by history, ultrasound, fever, or leukocytosis. On postoperative Day 1, the patients underwent cholescintigraphy (PIPIDA scan) analyzed by a board-certified radiologist for evidence of bile leaks. Postoperative cholescintigraphy revealed eight scans positive for bile leaks. Regardless of scan result, no patient experienced a clinically symptomatic bile leak. Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis with acceptable clinical and subclinical bile leak rates.

scholarly journals Single Scrotal Incision Orchiopexy in Children with Palpable Undescended Testis

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O A Elatrash ◽  
M S Eldebeiky ◽  
M S Elsherbeny ◽  
A N Elhoofy ◽  
E A A Hassan
Keyword(s):  
Prospective Study ◽  
Pediatric Surgery ◽  
Undescended Testis ◽  
Operating Time ◽  
Included Study ◽  
University Hospital ◽  
University Hospitals ◽  
Significant Difference ◽  
A Prospective Study ◽  
Surgery Department

Abstract Background Undescended testis or cryptorchidism is one of the most common congenital abnormalities of the genitourinary system in young boys, approximately 1-2% of boys at the age of 1 year have undescended testis, the disorder being unilateral in about 90% of cases and bilateral in about 10%. Aim of the Work We conducted this prospective study to assess the efficacy and safety of single-incision, transscrotal orchidopexy in children with palpable UDT. Patients and Methods A prospective study was adopted to fulfill the purpose of the study. The study was conducted at Pediatric Surgery Department, Ain Shams University Hospitals in Cairo. The included study population was pediatric patients with palpable, inguinal mal-descended testes who attend to Pediatric Surgery Outpatient Clinic, Ain Shams University Hospital till the fulfillment of the sample size. Results The most common sites of undescended testis were intracanalicular and scrotal neck regions. The most common postoperative complication was scrotal edema. Mean operating time was 21 minutes. There was no significant difference in the testicular size pre and post operative. Conclusion Based on these results, we concluded that the undescended testis represents a common pediatric problem requiring surgical intervention. Trans-scrotal orchidopexy is an effective, less invasive and highly acceptable cosmetically approach for the treatment of palpable undescended testis.

scholarly journals Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

2017 ◽  
Vol 4 (6) ◽  
pp. 1825
Author(s):  
Ashraf A. Helmy ◽  
Ayman M. A. Ali
Keyword(s):  
Bile Duct ◽  
Gastric Tube ◽  
Bile Leak ◽  
Good Alternative ◽  
University Hospitals ◽  
Bile Duct Injuries ◽  
Long Term Follow Up ◽  
A Prospective Study

Background: Bile duct injuries (BDI) constitute a disaster for both the patient and the surgeon without satisfactory results with the classic use of roux-en-Y hepaticojejunostomy (RYHJ). The purpose of this study was to evaluate our newly introduced technique utilizing isolated vascularized gastric tube (IVGT) as an alternative for RYHJ in reconstruction of the bile duct after iatrogenic BDI with lost segment.Methods: This is a prospective study included 18 consecutive patients suffered from iatrogenic BDI with lost segment admitted to Assiut and Sohag University Hospitals, during the period from September 2013 to June 2016. Patients were subjected to operative treatment with the interposition of IVGT to bridge the lost bile duct segment. Patients were evaluated regarding demographic criteria, clinical picture, different investigations, efficacy of the use of IVGT and evaluation of post-operative complications after a mean follow-up of 2 years.Results: Eighteen patients underwent repair of BDI utilizing IVGT during the study period. Three patients (17%) suffered immediate repairs, 10 patients (55%) experienced intermediate repairs and late repairs were performed for the last 5 patients (28%). Bile leak as a specific early morbidity was present in 3 patients (17%) with upper biliary tract injury without any operative mortality. Also, there was one patient with stent obstruction relieved by stent extraction. With long-term follow-up there was not any patient of biliary stricture.Conclusions: IVGT proved to be feasible and safe for bile duct replacement and is a good alternative for biliary reconstruction being more anatomical and physiological than RYHJ.

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

Causes and Treatment of Bile Leaks at the Puncture Site After Percutaneous Transhepatic Biliary Decompression

2019 ◽  
Vol 3 ◽  
pp. 8 ◽  
Author(s):  
Alireza Rasekhi ◽  
Nasir Babakhan Kondori
Keyword(s):  
Biliary Obstruction ◽  
Bile Leak ◽  
Bile Leakage ◽  
Malignant Biliary Obstruction ◽  
Biliary System ◽  
Pigtail Catheter ◽  
Puncture Site ◽  
Biliary Decompression ◽  
Stent Occlusion ◽  
Bile Leaks

Introduction: Bile leaks at the puncture site after percutaneous transhepatic biliary decompression (PTBD) are not uncommon and cause a lot of problems for patients with non-resectable biliary malignant obstruction. However, to the best of the authors’ knowledge, no study is conducted to establish the causes and to find an appropriate treatment. The current study was conducted on 264 patients who underwent PTBD for a malignant biliary obstruction. Material and Methods: This retrospective study reviewed 264 patients with non-resectable malignant biliary obstruction requiring PTBD. A two-stage biliary decompression is done. An 8Fr pigtail catheter is placed for PTBD, the patients would return after two days for stent placement. After stent placement, an 8 Fr pigtail catheter (internal – external) would be placed for flushing, and also for cholangiography. The patients are then observed for another two days. Patients who have persistent puncture site bile leakage after 24 hours are considered to have a bile leak. In these patients, cholangiography is performed. If cholangiography reveals stent occlusion, stent reopening by irrigation/ballooning is done. For those with patent stents and bile leakage, an internal-external biliary drain is placed which does not solve the problem, and a cholangiography is done into the drain tract via a syringe. Results: Sixteen of 264 patients who underwent percutaneous biliary decompression developed bile leakage at the puncture site. Twelve of these patients demonstrated an occluded biliary stent and their bile leak resolved after irrigation/ballooning. Four patients with bile leak demonstrated patent biliary stents and persistent leakage despite internal-external biliary drain placement. Cholangiograms in these patients demonstrated connections from the stented biliary system (the ipsilateral system), branches of a different occluded biliary system (the contralateral biliary tract), and the drain tract. All four patients underwent PTBD of the contralateral biliary system with subsequent resolution of their bile leak. Discussion: One of the complications of PTBD is bile leakage at the puncture site which could have two reasons. The most common is stent occlusion by clot and debris which can be managed by irrigation/ stenting. The second mechanism of bile leakage, not reported previously, was a fistulous connection between the drained biliary system (the ipsilateral system) and a separate obstructed biliary system (the contralateral system). We would like to refer to this mechanism of bile leak “Yo-Yo reflux” for its specific pattern of cholangiography. The Yo-Yo reflux mechanism of bile leaks occurs when a small branch from the adjacent separated contralateral system is transgressed inadvertently during ipsilateral biliary drainage. High-pressure bile fluid from the obstructed system flows through the lower pressure ipsilateral system and through the cannulation tract and onto the skin surface. In the Yo-Yo mechanism, stenting of the contralateral side is the only treatment. Conclusion: Bile leakage at the puncture site after PTBD has two major causes. The most common is stent occlusion by clot/debris which is diagnosed by cholangiography and treated by irrigation/ballooning. The second cause is Yo-Yo reflux which is diagnosed by cholangiography injecting directly into the orifice of skin fistula and treated by contralateral stenting.

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