White test versus conventional saline test in detecting intraoperative bile leakage in liver resection

Background
Intraoperative bile leakage testing is an important procedure in liver resection as it helps in detection of bile leaking points on the cut surface, thereby decreases postoperative bile leakage, which is one of the most dreadful complications following liver surgery. In this study, we tried to assess the efficacy of using White test in comparison with conventional saline test in detecting intraoperative bile leakage.
Patients and methods
In this study, we assessed whether the White test is better than the conventional saline test for the intraoperative detection of bile leakage in patients undergoing liver resection. This study included 100 patients who underwent elective liver resection. The conventional saline test (injecting an isotonic sodium chloride solution through the cystic duct) was carried out in 50 patients and the White test (injecting a fat emulsion solution through the cystic duct) was carried out in 50 patients.
Results
Incidence of postoperative bile leakage was compared between the conventional method and the White test. Bile leakage occurred in 22 (44%) patients in the conventional method group and in four (8%) patients in the White test group. In addition, the White test detected intraoperatively a significantly higher number of bile leakage sites compared with the conventional method. Therefore, the White test seems to be 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.