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Skipenko OG, Bedzhanyan AL, Chardarov NK, Ermak IB, Ermak AD, Rummo OO, Fedoruk DA, Kotenko OG, Kazaryan AM. Evaluation of the white test effectiveness for the prevention of bile leakage after liver resection: multicenter randomized controlled study. Updates Surg 2025:10.1007/s13304-025-02210-4. [PMID: 40307662 DOI: 10.1007/s13304-025-02210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/15/2025] [Indexed: 05/02/2025]
Abstract
Bile leakage is a common complication after liver resection. It often requires repeated interventions or surgery and prolongs the patient's recovery. The aim of the study was to assess the effectiveness of the leakage test with fat emulsion (the White Test) in preventing postoperative biliary complications. A multicenter (3 hospitals) randomized controlled trial was performed from February 2011 to May 2016. The trial involved only the patients scheduled for major hepatectomies. After liver transection and control of biliary tree leak-proofness, the patients were randomized into two groups-with and without applying the White Test. A comparative assessment of all the White Test participants was conducted. Forty-three patients formed the study group, and 36 patients were included in the control group. The White Test revealed sites of bile leakage (the positive White Test) in 37.2% (16/43) of the patients in the study group. These leakage sites were sealed intraoperatively. One of those patients (6.2%; 1/16) still developed bile leakage after surgery. Bile leakage was still observed in 7.4% (2/27) of patients after the negative White test. The incidence of postoperatively revealed bile leakage in the study and control groups did not have a statistically significant difference: 7% (3/43) and 8.3% (3/36), respectively. All bile leaks were grade B. This study demonstrated that the White Test did not provide any benefit in preventing postoperative bile leakage; therefore, other methods, such as ICG, should be further investigated.
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Affiliation(s)
- Oleg G Skipenko
- Department of Hepatopancreatobiliary Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Arkady L Bedzhanyan
- Department of Hepatopancreatobiliary Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia
- Department of Colorectal Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Nikita K Chardarov
- Department of Hepatopancreatobiliary Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Irina B Ermak
- Department of Hepatopancreatobiliary Surgery, Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Andrew D Ermak
- Department of Liver Transplantation, Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - Oleg O Rummo
- Department of Hepatopancreatobiliary Surgery, Minsk Scientific and Practical Centre of Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Dzmitry A Fedoruk
- Department of Hepatopancreatobiliary Surgery, Minsk Scientific and Practical Centre of Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Oleg G Kotenko
- Department of Hepatopancreatobiliary Surgery, Shalimov National Institute of Surgery and Transplantology, Kiev, Ukraine
| | - Airazat M Kazaryan
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital - Ullevål, Oslo, Norway.
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway.
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
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Hanaki T, Goto K, Tokuyasu N, Endo Y, Sunada H, Noma H, Sunaguchi T, Murakami Y, Matsunaga T, Yamamoto M, Sakamoto T, Hasegawa T, Fujiwara Y. Efficacy of indocyanine green systemic administration for bile leak detection after hepatectomy: a protocol for a prospective single-arm clinical trial with a historical control group. BMJ Open 2023; 13:e068223. [PMID: 36944457 PMCID: PMC10032385 DOI: 10.1136/bmjopen-2022-068223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Bile leakage (BL) after hepatectomy cannot always be detected with conventional methods; moreover, BL cannot be completely prevented. Recently, navigation procedures with indocyanine green (ICG) have been reported. Furthermore, we previously reported the possibility of detecting BLs with high sensitivity during hepatectomy by administering ICG into the bloodstream, which is quickly excreted in the bile. This study aims to verify whether detecting and addressing ICG leakage from the hepatic dissection plane using an ICG camera can reduce the bilirubin concentration in the drainage fluid, and consequently, the incidence of BL. METHODS AND ANALYSIS This prospective single-centre non-randomised single-arm trial will be conducted with historical controls. Overall, 85 patients will be enrolled, including 40 and 45 in the ICG and historical control groups, respectively. In the ICG group, 10 mg/2 mL of ICG will be transvenously or transportally administered during liver surgery. After its uptake by liver cells and excretion into bile, it will be visualised using a camera following the completion of hepatectomy, and the site of ICG leakage will be sutured. Moreover, we will record the number of bile leak spots detected by the naked eye and ICG camera. The primary endpoint of the study will be the total bilirubin concentration in the drain fluid on postoperative day 3, and we will determine whether the concentration differs significantly between the ICG and historical control groups. The results of our study will be used to suggest whether intraoperative ICG administration and evaluation at the hepatic dissection plane can be widely used in liver surgery for more reliable detection of BL and consequent reduction of biliary fistula. ETHICS AND DISSEMINATION The protocol was approved by the Certified Review Board of Tottori University Hospital (approval number: 21C002). Findings from this trial will be published in peer-reviewed journals and presented at academic conferences. TRIAL REGISTRATION NUMBER jRCTs061210043.
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Affiliation(s)
- Takehiko Hanaki
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Keisuke Goto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Naruo Tokuyasu
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yusuke Endo
- Department of Advanced Medicine, Tottori University, Tottori, Japan
| | - Hiroshi Sunada
- Department of Advanced Medicine, Tottori University, Tottori, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Teppei Sunaguchi
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yuki Murakami
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Tomoyuki Matsunaga
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Manabu Yamamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Teruhisa Sakamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Toshimichi Hasegawa
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
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Sakamoto K, Ogawa K, Tamura K, Iwata M, Sakamoto A, Matsui T, Nishi Y, Nagaoka T, Funamizu N, Takai A, Takada Y. Usefulness of a Balloon Catheter for Intraoperative Cholangiography During Living Donor Hepatectomy: A Product Investigation. Ann Transplant 2020; 25:e929062. [PMID: 33335083 PMCID: PMC7754690 DOI: 10.12659/aot.929062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intraoperative cholangiography (IOC) during living donor liver procurement for liver transplantation is an essential procedure to avoid biliary complications in the donor and to assess the details of the biliary anatomy of the graft liver for the recipient. There are limitations to IOC using conventional methods, including that the contrast medium often passes immediately to the duodenum, making continuous enhancement of the peripheral biliary tree difficult. The usefulness of a thin balloon catheter with side holes located proximal to the balloon for IOC was evaluated. MATERIAL AND METHODS A pediatric angiography balloon catheter was used for IOC. RESULTS The device was used in 2 living donors, and high-quality continuous images were easily achieved. There were no perioperative biliary complications in either donor. CONCLUSIONS A thin balloon catheter with side holes located proximal to the balloon catheter is useful in operations for both the donor and recipient because it allows more accurate division of the bile duct because of the clear IOC images.
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Shinkawa H, Tanaka S, Takemura S, Amano R, Kimura K, Nishioka T, Ito T, Miyazaki T, Ishihara A, Kubo S. Giving short-term prophylactic antibiotics in patients undergoing open and laparoscopic hepatic resection. Ann Gastroenterol Surg 2019; 3:506-514. [PMID: 31549010 PMCID: PMC6750139 DOI: 10.1002/ags3.12267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
AIM The 2016 guidelines of the Japan Society for Surgical Infection and the Japan Society of Chemotherapy advocate giving prophylactic antibiotics 1 hour before surgery and until 24 hours after surgery in patients undergoing elective hepatic resection. However, the efficacy of short-term antimicrobial prophylaxis has not been evaluated according to surgical approach. We evaluated the efficacy of giving prophylactic antibiotics in patients undergoing open or laparoscopic hepatic resection. METHODS The study comprised 218 and 185 patients undergoing open and pure laparoscopic hepatic resection, respectively. Incidence rates of postoperative infectious complications were compared between patients who received flomoxef sodium as the prophylactic antibiotic before and until 24 hours after surgery (short-term group) and those who received flomoxef sodium until 72 hours after surgery (long-term group) among patients undergoing open or laparoscopic hepatic resection. Propensity score matching analysis was carried out to adjust for confounding factors between the short- and long-term groups. RESULTS There was no significant difference in the postoperative infectious complication incidence between the short- and long-term groups among patients undergoing open (18.9% vs 12.2%; P = 0.36) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection after propensity score matching. Incidence rate of surgical site infections was comparable between the short- and long-term groups among patients undergoing open (13.5% vs 10.8%; P = 0.80) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection. CONCLUSION Giving short-term prophylactic antibiotics might be sufficient in preventing postoperative infectious complications in patients undergoing open and laparoscopic hepatic resection.
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Affiliation(s)
- Hiroji Shinkawa
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Shogo Tanaka
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Shigekazu Takemura
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Ryosuke Amano
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Kenjiro Kimura
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Takayoshi Nishioka
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Tokuji Ito
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Toru Miyazaki
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Atsushi Ishihara
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Shoji Kubo
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
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Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Stukenborg GJ, Zaydfudim VM. Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection. J Gastrointest Surg 2018; 22:661-667. [PMID: 29247421 PMCID: PMC5871550 DOI: 10.1007/s11605-017-3650-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality. METHODS Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak. RESULTS Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72-5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262). CONCLUSION Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.
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Affiliation(s)
- Allison N. Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Sowmya Narayanan
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Reid B. Adams
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA, USA,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
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Yang X, Qiu Y, Wang W, Feng X, Shen S, Li B, Wen T, Yang J, Xu M, Chen Z, Yan L. Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis. Medicine (Baltimore) 2017; 96:e8774. [PMID: 29145333 PMCID: PMC5704878 DOI: 10.1097/md.0000000000008774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Postoperative bile leakage (BL) is a major complication of hepatic alveolar echinococcosis (HAE). The purpose of this study was to identify the risk factors for BL and to establish a simple scoring system for predicting BL.A total of 152 patients with HAE were included in the study between May 2004 and December 2016. The patient's baseline data, laboratory blood tests, imaging features, and surgical management were collected. Univariate and multivariate analyses were used to screen for factors to predict BL. The cutoff values for those factors and predictive value of a model were determined by receiver operative characteristic curve (ROC) analysis.BL was detected in 22 of the 152 patients. Univariate analyses showed significant differences in the lesion diameter, levels of lactate dehydrogenase (LDH), alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and direct bilirubin (DBIL), inferior vena cava invasion, surface area of hepatectomy, blood loss and history of percutaneous transhepatic cholangial drainage between patients with and without BL. On multivariate analyses, DBIL > 7.1 μmol/L, LDH > 194 U/L, lesion diameter > 12 cm and a larger surface area of hepatectomy were independent predictors of BL. The resulting area under the ROC of the scoring model was 0.724 (95% CI, 0.646-0.793).The lesion diameter, DBIL, larger surface area of hepatectomy, and elevated LDH were the important factors affecting the occurrence of BL after surgery. The risk score model will help the clinician to assess BL before surgery. More studies are needed to confirm the scoring model and risk factors.
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Trehan V, Rao PP, Naidu C, Sharma AK, Singh A, Sharma S, Gaur A, Kulkarni S, Pathak N. Hydrogen peroxide test for intraoperative bile leak detection. Med J Armed Forces India 2017; 73:256-260. [PMID: 28790783 PMCID: PMC5533545 DOI: 10.1016/j.mjafi.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively. Topical application of 1.5% diluted hydrogen peroxide (H2O2) was used to detect the BL from cut surface of liver and we compared this with conventional saline method to know the efficacy. METHODS A total of 31 patients included all patients who underwent liver resection and donor hepatectomies as part of Living Donor Liver Transplantation. After complete liver resection, the conventional saline test followed by topical diluted 1.5% H2O2 test was performed on all. RESULTS A BL was demonstrated in 11 patients (35.48%) by the conventional saline method and in 19 patients (61.29%) by H2O2 method. Statistically compared by Wilcoxon signed-rank test showed significant difference (P = 0.014) for minor liver resections group and (P = 0.002) for major liver resections group. CONCLUSION The topical application of H2O2 is a simple and effective method of detection of BL from cut surface of liver. It is an easy, non-invasive, cheap, less time consuming, reproducible, and sensitive technique with no obvious disadvantages.
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Affiliation(s)
- V. Trehan
- Classified Specialist (Surgery) & G I Surgeon, Base Hospital, Delhi Cantt 110010, India
| | - Pankaj P. Rao
- Senior Advisor (Surgery & G I Surgery), Command Hospital (Southern Command), Pune 411040, India
| | - C.S. Naidu
- Professor & Head, Department of Surgery, Armed Forces Medical College, Pune 411040, India
| | - Anuj K. Sharma
- Senior Advisor (Surgery & G I Surgery), Army Hospital (R&R), New Delhi, India
| | - A.K. Singh
- Senior Advisor (Surgery & G I Surgery), Army Hospital (R&R), New Delhi, India
| | - Sanjay Sharma
- Senior Advisor (Surgery & G I Surgery), Command Hospital (Northern Command) C/o 56 APO, India
| | - Amit Gaur
- Classified Specialist (Surgery) & G I Surgeon, 5 Air Force Hospital, C/o 99 APO, India
| | - S.V. Kulkarni
- Classified Specialist (Surgery & G I Surgery) Army Hospital (R&R), New Delhi, India
| | - N. Pathak
- Classified Specialist (Surgery & G I Surgery) Army Hospital (R&R), New Delhi, India
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Kajiwara T, Midorikawa Y, Yamazaki S, Higaki T, Nakayama H, Moriguchi M, Tsuji S, Takayama T. Clinical score to predict the risk of bile leakage after liver resection. BMC Surg 2016; 16:30. [PMID: 27154038 PMCID: PMC4859985 DOI: 10.1186/s12893-016-0147-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 04/30/2016] [Indexed: 12/12/2022] Open
Abstract
Background In liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection. Methods We analyzed the postoperative course in 518 patients who underwent liver resection for malignancy to identify independent predictors of bile leakage, which was defined as “a drain fluid bilirubin concentration at least three times the serum bilirubin concentration on or after postoperative day 3,” as proposed by the International Study Group of Liver Surgery. To confirm the robustness of the risk score system for bile leakage, we analyzed the independent series of 289 patients undergoing liver resection for malignancy. Results Among 81 (15.6 %) patients with bile leakage, 76 had grade A bile leakage, and five had grade C leakage and underwent reoperation. The median postoperative hospital stay was significantly longer in patients with bile leakage (median, 14 days; range, 8 to 34) than in those without bile leakage (11 days; 5 to 62; P = 0.001). There was no hepatic insufficiency or in-hospital death. The risk score model was based on the four independent predictors of postoperative bile leakage: non-anatomical resection (odds ratio, 3.16; 95 % confidence interval [CI], 1.72 to 6.07; P < 0.001), indocyanine green clearance rate (2.43; 1.32 to 7.76; P = 0.004), albumin level (2.29; 1.23 to 4.22; P = 0.01), and weight of resected specimen (1.97; 1.11 to 3.51; P = 0.02). When this risk score system was used to assign patients to low-, middle-, and high-risk groups, the frequency of bile leakage in the high-risk group was 2.64 (95 % CI, 1.12 to 6.41; P = 0.04) than that in the low-risk group. Among the independent series for validation, 4 (5.7 %), 16 (10.0 %), and 10 (16.6 %) patients in low-, middle, and high-risk groups were given a diagnosis of bile leakage after operation, respectively (P = 0.144). Conclusions Our risk score model can be used to predict the risk of bile leakage after liver resection.
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Affiliation(s)
- Takahiro Kajiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Shintaro Yamazaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shingo Tsuji
- Genome Science Division, Research Center for Advanced Science and Technologies, University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Liu M, Liu Z, Jin H, Jiao Y. The efficacy of fat emulsion and normal saline for bile leakage tests during hepatic resection: A randomized trial. J Int Med Res 2015; 43:378-84. [PMID: 25755251 DOI: 10.1177/0300060515569286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A randomized controlled trial to evaluate the use of fat emulsion and normal saline for bile leakage tests during hepatic resection. METHODS Patients were randomized to undergo intraoperative bile leakage tests with saline then fat emulsion (Group A), or fat emulsion then saline (Group B). All patients received both tests. RESULTS In group A (n = 64), saline revealed 53 leakage points in 27 patients, and fat emulsion revealed 42 additional points in a further nine patients. In group B (n = 64), fat emulsion revealed 87 leakage points in 37 patients, and saline revealed three additional points in three patients. There were no significant between-group differences in the number of leakage points detected by the first test, total number of leakage points or postoperative complications. Significantly more leakage points were detected by the second test in Group A (fat emulsion) than in Group B (saline). CONCLUSIONS Fat emulsion then saline identifies more leakage points after the first test than saline then fat emulsion. There is no difference in the total number of leakage points detected, regardless of which method is used first.
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Affiliation(s)
- Ming Liu
- Department of General Surgery, Fourth Hospital of JiLi University, ChangChun, China
| | - Zhiyi Liu
- Department of General Surgery, Fourth Hospital of JiLi University, ChangChun, China
| | - Hu Jin
- Department of General Surgery, Fourth Hospital of JiLi University, ChangChun, China
| | - Yonggeng Jiao
- Department of General Surgery, Fourth Hospital of JiLi University, ChangChun, China
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Kaibori M, Shimizu J, Hayashi M, Nakai T, Ishizaki M, Matsui K, Kim YK, Hirokawa F, Nakata Y, Noda T, Dono K, Nozawa A, Kwon M, Uchiyama K, Kubo S. Late-onset bile leakage after hepatic resection. Surgery 2015; 157:37-44. [DOI: 10.1016/j.surg.2014.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022]
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Qiu J, Wu H, Bai Y, Xu Y, Zhou J, Yuan H, Chen S, He Z, Zeng Y. Mesohepatectomy for centrally located liver tumours. Br J Surg 2014; 100:1620-6. [PMID: 24264785 DOI: 10.1002/bjs.9286] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mesohepatectomy (MH) avoids unnecessary sacrifice of functional parenchyma compared with extended hepatectomy (EH). The aim of this study was to compare the results of MH with those of EH in the management of centrally located liver tumours (CLLTs). METHODS All patients with CLLTs treated by liver resection between 2005 and 2011 were enrolled in this retrospective study. The decision to use MH or EH was made on an individual basis. Outcomes of the procedures were compared and a classification system for MH was devised consisting of four types, with type IV representing the most complex procedure. RESULTS MH was performed in 292 patients and EH in 138. MH was associated with a longer duration of operation (P < 0.001), higher intraoperative transfusion rate (P < 0.001) and lower complication rates (P = 0.001) compared with EH. There were no significant differences in hepatic inflow occlusion rate (P = 0.075), blood loss (P = 0.241) and length of hospital stay (P = 0.804) between the two groups. Type IV lesions had the longest duration of operation, greatest blood loss, and highest intraoperative transfusion and morbidity rates (all P < 0.050). CONCLUSION MH is a feasible and safe alternative to EH in selected patients with CLLTs. The proposed classification system may be useful in guiding the surgical treatment of CLLTs.
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Affiliation(s)
- J Qiu
- Departments of Hepatobiliary Pancreatic Surgery and
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Wang HQ, Yang J, Yang JY, Yan LN. Bile leakage test in liver resection: A systematic review and meta-analysis. World J Gastroenterol 2013; 19:8420-8426. [PMID: 24363535 PMCID: PMC3857467 DOI: 10.3748/wjg.v19.i45.8420] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess systematically the safety and efficacy of bile leakage test in liver resection.
METHODS: Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate postoperative bile leakage, intraoperative positive bile leakage, and complications. We used either the fixed-effects or random-effects model.
RESULTS: Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection. The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group (RR = 0.39, 95%CI: 0.23-0.67; I2 = 3%). The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test (RR = 2.38, 95%CI: 1.24-4.56, P = 0.009). No significant intergroup differences were observed in total number of complications, ileus, liver failure, intraperitoneal hemorrhage, pulmonary disorder, abdominal infection, and wound infection.
CONCLUSION: The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications. Fat emulsion is the best choice of solution for the test.
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Liu Z, Jin H, Li Y, Gu Y, Zhai C. Randomized controlled trial of the intraoperative bile leakage test in preventing bile leakage after hepatic resection. Dig Surg 2013; 29:510-5. [PMID: 23392477 DOI: 10.1159/000346480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 12/10/2012] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the value of an intraoperative bile leakage test during liver resection in preventing bile leakage after hepatic resection. METHODS A sterile fat emulsion was injected through the duct of the gallbladder among patients from the treatment group so as to observe leakage status on the hepatic resection plane; the leakage points were dealt with in time. The hepatic resection plane was treated using conventional methods among patients from the control group. RESULTS The incidence rates of the bile leakage and other complications in the two groups were analyzed in this study. Two (3.7%) of the 53 patients from the treatment group had bile leakage, and 8 (14.8%) of the 54 patients from the control group had bile leakage. There were significant differences between the two groups (p < 0.05) in terms of the incidence of the bile leakage. With regard to the incidence of other complications, there were no significant differences between the two groups (p > 0.05). CONCLUSIONS An intraoperative bile leakage test appears to be sensitive in detecting interoperative bile leaks and can effectively prevent bile leakage after hepatic resection, and it does not increase the likelihood of other complications.
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Affiliation(s)
- Zhiyi Liu
- Department of General Surgery, The Fourth Hospital of Ji Lin University, Changchun, PR China.
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Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Yamamoto J. Predictive factors for bile leakage after hepatectomy: analysis of 505 consecutive patients. World J Surg 2011; 35:1898-903. [PMID: 21519973 DOI: 10.1007/s00268-011-1114-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bile leakage is the most common complication after hepatectomy and its incidence is not declining. The aim of the present study was to identify predictive factors for bile leakage. METHODS Clinical data from 505 consecutive patients who underwent hepatectomy without extrahepatic bile duct resection in our department between January 2006 and December 2009 were reviewed retrospectively. RESULTS The incidence of bile leakage was found to be 6.7%. Multivariate analysis identified three independent factors that were significantly correlated with the occurrence of bile leakage: (1) repeat hepatectomy (P = 0.002; odds ratio [OR] 3.439; 95% confidence interval [CI] 1.552-7.618), (2) a cut surface area ≥57.5 cm(2) (P = 0.004; OR 5.296; 95% CI 1.721-16.302), and (3) intraoperative blood loss ≥775 ml (P = 0.01; OR 2.808; 95% CI 1.280-6.160). CONCLUSION More meticulous management is needed to prevent bile leakage in high-risk patients.
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Affiliation(s)
- Ryuji Yoshioka
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8500, Japan
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Abstract
The incidence of complications after hepatectomy has been considerably reduced over the last 20 years. Better knowledge of liver anatomy and liver regeneration, and methods preventing bleeding during surgery have resulted in morbidity rates below 20% and mortality rates less than 5%. The treatment of the liver cross section remains controversial. Experimental studies have reported convincing biological effects of fibrin sealants or compresses when applied on the liver to decrease hemorrhagic or biliary complications. However, clinical studies are very heterogeneous, providing conflicting results compromising recommendations for routine use.
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Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery 2011; 150:91-8. [PMID: 21514613 DOI: 10.1016/j.surg.2011.02.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/10/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bile leakage is a common complication of hepatectomy, and is associated with an increase in sepsis and liver failure. There are no standard preventive methods against bile leakage after hepatic surgery. The aim of the present randomized clinical trial was to evaluate the application of indocyanine green (ICG) fluorescent cholangiography for preventing postoperative bile leakage. METHODS 102 patients who underwent hepatic resection without biliary reconstruction were divided into 2 groups. The control group (n = 50) underwent a leak test with ICG dye alone, and the experimental group underwent a leak test with ICG dye, followed by ICG fluorescent cholangiography using the Photodynamic Eye (PDE group, n = 52). RESULTS Among 42 patients with fluorescence in the PDE group, 25 patients had insufficient closure of bile ducts on the cut surface of the liver, which were closed by suture or ligation. There were 5 patients who developed postoperative bile leakage in the control group versus no bile leakage in the PDE group (10% vs 0%, P = .019). CONCLUSION ICG fluorescent cholangiography could detect insufficiently closed bile ducts that could not be identified by a standard bile leak test. ICG fluorescent cholangiography may have useful potential for prevention of bile leakage after hepatic resection.
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Affiliation(s)
- Masaki Kaibori
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka 573-1191, Japan.
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Abstract
The normal indigenous intestinal microflora consists of about 10(15) bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.
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Affiliation(s)
- Einar Husebye
- Clinic of Medicine, Hospital of Buskerud HF, Drammen, and Division of Medicine, Ullevaal University Hospital of Oslo, Oslo, Norway.
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Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, Takemura S, Yamamoto T, Uenishi T, Kinoshita H. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 2002; 195:484-9. [PMID: 12375753 DOI: 10.1016/s1072-7515(02)01288-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile leakage is one of the frequent and disturbing complications of hepatic resection. STUDY DESIGN Clinical records of the 363 patients who underwent hepatic resections without biliary reconstruction for hepatic cancers between January 1994 and June 2001 were reviewed. Postoperative bile leakage was defined as continuous drainage with a bilirubin concentration of 20 mg/dL or 1,500 mg/d lasting 2 days. Leakage that continued longer than 2 weeks or that required surgical intervention was defined as uncontrollable. Differences in incidence and frequency of uncontrollable leakage for the different types of hepatic resection, tumors, and underlying liver disease were investigated. Outcomes after treatment for uncontrollable bile leakage were also reviewed. RESULTS Postoperative bile leakage occurred in 26 of 363 patients (7.2%). Although the incidence in patients with cholangiocellular carcinoma (3/9 [33%]) was higher (p = 0.03) than in patients with hepatocellular carcinoma, rates of occurrence were similar among the different types of hepatic resection and underlying liver disease. Eight of the 26 patients (31%) had uncontrollable leakage. Two patients required reoperation to control leakage; one of these developed hepatic failure and died 2 months after surgery. Four patients underwent endoscopic nasobiliary drainage 21 to 34 days after hepatectomy, and the leakage resolved within 3 to 21 days. Fibrin glue sealing was effective in two patients whose leaking bile ducts were not connected to the common bile duct. CONCLUSIONS Although meticulous surgical technique can minimize the risk of postoperative bile leakage, some instances of leakage are unavoidable. Nonsurgical treatments, such as nasobiliary drainage or fibrin glue sealing, are preferable to reoperation.
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Affiliation(s)
- Shogo Tanaka
- Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
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