Detection of Bile Leakage After Hepatic Resection by Intraoperative Indocyanine Green Fluorescent Imaging

  • Masaki KaiboriEmail author
  • Kosuke Matsui
  • Morihiko Ishizaki
  • Masanori Kon


Bile leakage is one of the most common complications after hepatic resection, and is associated with postoperative sepsis and liver failure. However, there are no standard methods of preventing bile leakage after hepatic surgery. We present here the use of indocyanine green (ICG) fluorescent cholangiography for preventing postoperative bile leakage. The subjects were 132 patients who underwent hepatic resection without biliary reconstruction. Patients underwent a leakage test using ICG dye, followed by ICG fluorescent cholangiography using the Photodynamic Eye. Postoperative bile leakage occurred in 7/132 patients (5 %) and persisted for a median period of 6 weeks. The incidence of postoperative bile leakage was 0 % in patients with type A pattern of fluorescence (no fluorescence type: no fluorescence detected on the cut surface of the liver, suggesting absence of bile ducts at the surgical margin; n = 37), 2 % in patients with type B pattern (intact bile duct type: fluorescence showed one or more intact bile ducts on the cut surface; n = 51), 6 % in patients with type C pattern (injured bile duct type: leakage of dye from one or more bile duct stumps on the cut surface; n = 31), and 31 % in patients with type D pattern (unconfirmed type: leakage of dye from the cut surface, but the source was unclear; n = 13). ICG fluorescent cholangiography detected insufficiently closed bile duct stumps that were not identified by the standard bile leakage test. ICG fluorescent cholangiography may be useful for preventing bile leakage after hepatic resection, but patients with type D pattern of fluorescence should be carefully monitored for leakage for several weeks.


Hepatic resection Intraoperative indocyanine green fluorescent imaging Postoperative bile leakage Injured bile duct type Unconfirmed bile duct type 

Supplementary material

Video 18.1

The areas showing white spots were compressed with gauze, and leakage was tested by additional injection of 3–5 ml of saline (WMV 14,429 kb)

Video 18.2

The pattern of fluorescence classified as unconfirmed type (Type D, leakage of dye from the cut surface, but the source was unclear; n = 13/95 patients) (WMV 14,790 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Masaki Kaibori
    • 1
    Email author
  • Kosuke Matsui
    • 1
  • Morihiko Ishizaki
    • 1
  • Masanori Kon
    • 1
  1. 1.Department of Surgery, Hirakata HospitalKansai Medical UniversityHirakataJapan

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