Meta-Analysis
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World J Gastroenterol. Dec 7, 2013; 19(45): 8420-8426
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8420
Bile leakage test in liver resection: A systematic review and meta-analysis
Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan
Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang HQ, Yang JY, Yang J and Yan LN designed the study, performed the literature search and analyzed the data; Yan LN and Yang JY interpreted the results; Wang HQ and Yang J wrote the paper.
Supported by National Science and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002-017
Correspondence to: Lu-Nan Yan, MD, PhD, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province,China. yanlunan_688@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: August 18, 2013
Revised: October 1, 2013
Accepted: October 17, 2013
Published online: December 7, 2013
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.

Keywords: Bile leakage test, Bile leakage, Liver resection, Postoperative complications, Meta-analysis

Core tip: Bile leakage is a common complication after hepatic resection and seriously affects postoperative quality of life. The bile leakage test was introduced to prevent bile leakage after liver resection. Many studies have evaluated the feasibility, safety and efficacy of the bile leakage test, however, the clinical significance of this technique remains inconsistent. We conducted a systematic review and showed that the bile leakage test reduced the incidence of postoperative bile leakage and did not increase the incidence of complications. In addition, fat emulsion may be the best choice of solution for the bile leakage test.