Bile leakage test in liver resection: a systematic review and meta-analysis

World J Gastroenterol. 2013 Dec 7;19(45):8420-6. doi: 10.3748/wjg.v19.i45.8420.


Aim: To assess systematically the safety and efficacy of bile leakage test in liver resection.

Methods: Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate postoperative bile leakage, intraoperative positive bile leakage, and complications. We used either the fixed-effects or random-effects model.

Results: Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection. The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group (RR = 0.39, 95%CI: 0.23-0.67; I (2) = 3%). The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test (RR = 2.38, 95%CI: 1.24-4.56, P = 0.009). No significant intergroup differences were observed in total number of complications, ileus, liver failure, intraperitoneal hemorrhage, pulmonary disorder, abdominal infection, and wound infection.

Conclusion: The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications. Fat emulsion is the best choice of solution for the test.

Keywords: Bile leakage; Bile leakage test; Liver resection; Meta-analysis; Postoperative complications.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anastomotic Leak / diagnosis*
  • Anastomotic Leak / etiology
  • Bile Duct Diseases / diagnosis*
  • Bile Duct Diseases / etiology
  • Chi-Square Distribution
  • Diagnostic Techniques, Digestive System*
  • Fat Emulsions, Intravenous
  • Hepatectomy / adverse effects*
  • Humans
  • Indocyanine Green
  • Methylene Blue
  • Odds Ratio
  • Predictive Value of Tests


  • Fat Emulsions, Intravenous
  • Indocyanine Green
  • Methylene Blue