The value of intraoperative White-Test for biliary leakage following hepatic resection

Background:

Bile leakage testing may help to detect and reduce the incidence of biliary leakage after hepatic resection. A meta-analysis of medium quality studies (individual cohort studies including low quality randomized controlled trials) revealed, that the use of the White-Test leads to a significant reduction of post-operative biliary leakage (OR: 0.3 (95% CI: 0.14, 0.63), p = 0.002).

Patients and Methods:

Retrospective analysis of patients undergoing liver resection in 2012 and 2013. Patients were split into two groups (+/- intraoperative White-Test). Biliary leakage was defined in accordance with ISGLS definition for biliary leakage.

Results:

A total of 251 consecutive patients undergoing liver resection were included in the analysis. Data are given as median with interquartile range. Age was 64 years (51; 71). 135 patients (54%) underwent major resection. White-Test was carried out in 69 (27%) vs. 182 (73%) without any specific intraoperative leakage-test. A total of 62 bile leakages occurred post-operatively (25%, grade A:16, grade B:39, grade C:7). There was no statistically significant difference in patients with White-Test (13/69:18.8%) compared to no intraoperative testing (49/182:26.9%) (p = 0.18; OR:0.63). In patients with major resections, the trend for less biliary leakages was stronger when using White-Test (10/48:20.8% vs. 28/87; 32.2%) but still not statistically significant (p = 0.14; OR: 0.55).

Conclusion:

Our findings do not confirm former findings for the use of the White-Test to identify bile leaks intraoperatively. There is a trend towards better outcome when using the White-Test. Nonetheless, there is a requirement for a RCT with adequately powered sample-size and clear definitions of outcome parameters to identify the clinical value of the test.

Corresponding author: Linke, Richard

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