Langenbeck's Archives of Surgery

, 394:1019 | Cite as

Intraoperative application of “white test” to reduce postoperative bile leak after major liver resection: results of a prospective cohort study in 137 patients

  • Jun Li
  • Massimo Malagó
  • Georgios C. Sotiropoulos
  • Hauke Lang
  • Randolph Schaffer
  • Andreas Paul
  • Christoph E. Broelsch
  • Silvio NadalinEmail author
Original Article



This study aimed to prove the clinical validation of the recently developed bile leakage test, “white test” (WT), in major liver resection.

Materials and methods

From June 2005 to June 2007, the study was carried out in a prospective consecutive fashion, including 74 patients without bile leakage test as the control group while 63 patients undergoing white test as the study group. The incidences of bile leakage within the 30th postoperative day in both groups were compared.


Postoperative bile leakage was found in 22.9% patients in the control group and in 5.3% patients in the WT group, respectively (p < 0.01). In univariate analysis, not performing a white test, Klatskin tumor, biliary-enteric anastomosis, and longer operation time were associated with an increase of bile leakage. The multivariate analysis showed that not performing the WT was the only significant factor influencing the occurrence of postoperative bile leakage (p = 0.02).


The white test is a feasible and sensitive bile leakage test with no obvious disadvantages. It could be a possible standardized method to prevent bile leakage in major liver resection.


Bile leakage Bile leakage test Liver surgery Complication 


  1. 1.
    Yamashita Y, Hamatsu T, Rikimaru T et al (2001) Bile leakage after hepatic resection. Ann Surg 233:45–50 doi: 10.1097/00000658-200101000-00008 CrossRefPubMedGoogle Scholar
  2. 2.
    Lo CM, Fan ST, Liu CL et al (1998) Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg 133:156–161 doi: 10.1001/archsurg.133.2.156 CrossRefPubMedGoogle Scholar
  3. 3.
    Capussotti L, Ferrero A, Vigano L et al (2006) Bile leakage and liver resection: where is the risk? Arch Surg 141:690–694 doi: 10.1001/archsurg.141.7.690 CrossRefPubMedGoogle Scholar
  4. 4.
    Erdogan D, Busch OR, Gouma D et al (2007) Prevention of biliary leakage after partial liver resection using topical hemostatic agents. Dig Surg 24:294–299 doi: 10.1159/000103661 CrossRefPubMedGoogle Scholar
  5. 5.
    Figueras J, Llado L, Miro M et al (2007) Application of fibrin glue sealant after hepatectomy does not seem justified: results of a randomized study in 300 patients. Ann Surg 245:536–542 doi: 10.1097/01.sla.0000245846.37046.57 CrossRefPubMedGoogle Scholar
  6. 6.
    Benzoni E, Cojutti A, Lorenzin D et al (2007) Liver resective surgery: a multivariate analysis of postoperative outcome and complication. Langenbecks Arch Surg 392:45–54 doi: 10.1007/s00423-006-0084-y CrossRefPubMedGoogle Scholar
  7. 7.
    Ijichi M, Takayama T, Toyoda H et al (2000) Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg 135:1395–1400 doi: 10.1001/archsurg.135.12.1395 CrossRefPubMedGoogle Scholar
  8. 8.
    Nakai T, Kawabe T, Shiraishi O et al (2004) Prevention of bile leak after major hepatectomy. Hepatogastroenterology 51:1286–1288PubMedGoogle Scholar
  9. 9.
    Lam CM, Lo CM, Liu CL et al (2001) Biliary complications during liver resection. World J Surg 25:1273–1276 doi: 10.1007/s00268-001-0109-1 CrossRefPubMedGoogle Scholar
  10. 10.
    Tanaka S, Hirohashi K, Tanaka H et al (2002) Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 195:484–489 doi: 10.1016/S1072-7515(02)01288-7 CrossRefPubMedGoogle Scholar
  11. 11.
    Nadalin S, Li J, Lang H et al (2008) The white test: a new dye test for intraoperative detection of bile leakage during major liver resection. Arch Surg 143:402–404 doi: 10.1001/archsurg.143.4.402 CrossRefPubMedGoogle Scholar
  12. 12.
    Nagano Y, Togo S, Tanaka K et al (2003) Risk factors and management of bile leakage after hepatic resection. World J Surg 27:695–698 doi: 10.1007/s00268-003-6907-x CrossRefPubMedGoogle Scholar
  13. 13.
    Karoui M, Penna C, min-Hashem M et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243:1–7 doi: 10.1097/01.sla.0000193603.26265.c3 CrossRefPubMedGoogle Scholar
  14. 14.
    Kovalcik PJ, Burrell MJ, Old WL Jr (1983) Cholecystectomy concomitant with other intra-abdominal operations. Assessment of risk. Arch Surg 118:1059–1062PubMedGoogle Scholar
  15. 15.
    Stewart L, Pellegrini CA, Way LW (1988) Cholangiovenous reflux pathways as defined by corrosion casting and scanning electron microscopy. Am J Surg 155:23–28 doi: 10.1016/S0002-9610(88)80253-8 CrossRefPubMedGoogle Scholar
  16. 16.
    Yoshimoto H, Ikeda S, Tanaka M et al (1989) Relationship of biliary pressure to cholangiovenous reflux during endoscopic retrograde balloon catheter cholangiography. Dig Dis Sci 34:16–20 doi: 10.1007/BF01536148 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jun Li
    • 1
  • Massimo Malagó
    • 1
  • Georgios C. Sotiropoulos
    • 1
  • Hauke Lang
    • 1
  • Randolph Schaffer
    • 1
  • Andreas Paul
    • 1
  • Christoph E. Broelsch
    • 1
  • Silvio Nadalin
    • 1
    Email author
  1. 1.Department of General, Visceral, and Transplant SurgeryUniversity Hospital EssenEssenGermany

Personalised recommendations