The role of bile leak testing in liver resection: a systematic review and meta-analysis

Abstract

Background: Bile leak following liver resection can be associated with significant morbidity. This systematic review and meta-analysis aims to evaluate the effect of intraoperative bile leak testing on postoperative bile leak rate and other complications after liver resection without biliary reconstruction for any cause. Methods: PubMed, MEDLINE, Embase, Cochrane Library and grey literature databases were searched for articles between 1960 and 2017 comparing bile leak rates with or without bile leak testing. Standard meta-analysis methods were used. The primary outcome was bile leak rate, and secondary outcomes were overall morbidity, reintervention rate and length of stay. Results: 8 articles met inclusion criteria. Intraoperative bile leak testing after resection was associated with lower postoperative bile leak rate (4.1% vs 12.3%, OR 0.36, 95% CI 0.23-0.55, p < 0.001), overall morbidity (OR 0.67, 95% CI 0.47-0.96, p = 0.030), need for reintervention (OR 0.11, 95% CI 0.03-0.36, p < 0.001) and a shorter duration of hospital stay (2.21 days, 95% CI 0.69-3.73, p = 0.004). Conclusion: The routine use of intraoperative bile leak testing during liver resection results in a significant reduction in postoperative bile leak rate, overall morbidity, length of hospital stay and need for reintervention. Bile leak testing should be performed after liver resection without biliary reconstruction.

Outcomes of simultaneous laparoscopic, hybrid, and open resection in colorectal cancer with synchronous liver metastases: a propensity score-matched study

“…Among the liver morbidity, the more biliary collection tendency was observed initially in the laparoscopic group than open hepatectomy groups (5.9% vs. 0.6% vs. 2.9%, p = 0.098), and the difference with the hybrid group was significant after matching. Although the incidence was still low compared to 3.6–33% of previous studies 36 , the higher biliary collection in the laparoscopic group may be due to the pneumoperitoneum, which prevents the bile leak on the cut liver surface during liver parenchymal transection, making it difficult to find the bile leakage points, and the difficulty of controlling the bile leakage points with suture ligation 23 , 37 .…”

Protocol of a randomised controlled phase II clinical trial investigating PREoperative endoscopic injection of BOTulinum toxin into the sphincter of Oddi to reduce bile leakage after hepatic resection: the PREBOT-II trial

“…The results showed that the evidence is scanty and unconvincing. 9 Furthermore, the kind of surgical transection and surgical closure techniques have been evaluated. In the early 1970s the clamp-crushing technique as a novel technique for hepatic resections was introduced.…”

“…A recent systematic review and meta-analysis on this topic studied the role of bile leak testing during liver resection including test substances like normal saline, methylene blue, fat emulsion, indocyanine green and air. The results showed that the evidence is scanty and unconvincing 9. Furthermore, the kind of surgical transection and surgical closure techniques have been evaluated.…”

Mô tả biến chứng rò mật và tràn dịch màng phổi giữa 2 nhóm cắt gan mở và cắt gan nội soi điều trị ung thư biểu mô tế bào gan

“…Nghiên cứu của Yun (2017), đã cho rằng: Điều trị không mổ là chiến lược điều trị hiệu quả và xâm lấn tối thiểu đối với rò mật sau mổ, và lựa chọn phương pháp điều trị tuỳ thuộc từng loại rò mật; trong đó, nội soi mật tuỵ ngược dòng nên được xem là phương thức đầu tiên trong chẩn đoán và điều trị rò mật sau phẫu thuật gan mật [12]. Vaska và cộng sự (2019) đã kết luận: Kiểm tra rò mật thường quy trong mổ cắt gan làm giảm đáng kể tỷ lệ rò mật, thời gian nằm viện [13].…”