Effect of tracing bile duct leaks using intralipid injection through the cystic duct stump versus saline injection followed by cholangiography on posthepatectomy biliary complications

Taha, Mohamed; Fayed, Yahya; Aboushady, Mohamed; Marwan, Ibrahim; Abdel-Samea, Mohammed E.; Yassein, Taha

doi:10.4103/ejs.ejs_163_21

Effect of tracing bile duct leaks using intralipid injection through the cystic duct stump versus saline injection followed by cholangiography on posthepatectomy biliary complications

Authors

Abstract

Background
Bile leakage is a common and serious complication after hepatic resection. It is important to prevent it by early detection and repair of leaking points intraoperatively and hence minimizing postoperative leaks. In this study, the authors prospectively compared the effect of transcystic intralipid injection versus saline test and then cholangiography on biliary complications in different cases of liver resection.
Patients and methods
This is a prospective randomized clinical trial in which we compared between the use of the White test and the use of saline test followed by cholangiography for the intraoperative detection of bile leakage in patients who underwent liver resection with cholecystectomy. The 52 cases were carried out in the National Liver Institute from May 2019 till March 2021.
Results
The incidence of postoperative bile leakage in both groups was compared. Bile leakage occurred in nine (34.6%) patients in the conventional saline and then cholangiography and in three (11.5%) patients in the White test group; this was statistically significant (=0.048). In addition, the White test detected intraoperatively a significantly larger number of bile leakage sites (seven cases) compared with the saline and then cholangiography group (two cases).
Conclusion
Based on the results of this study, the authors strongly recommend using the white test to saline test and then cholangiography as the bile leak test of choice in minimizing posthepatectomy bile leak.

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