A frequent side effect of partial hepatectomy for hepatocellular carcinoma (HCC) is bile leakage (BL). However, because of the lack of consensus about the usefulness of the numerous intraoperative methods for BL detection and the difficulty of their usage, they have not been generally used.

To ascertain the pressures produced in the gallbladder and common bile duct (CBD) during the test, a unique BL-detection method (Peng’s test) was devised in a pig model. Then, in partial hepatectomy for HCC, comparison research was done between a prospective cohort of patients using Peng’s test and a retrospective historical cohort patient group using the White Gauze test. Confounding variables were balanced using 1:1 ratio propensity score matching (PSM).

The highest pressures were 103.8±11.8 and 42.3±6.1, respectively, with methylene blue injection in the gallbladder and CBD without Pringle’s technique in the 4 swine. Following Pringle’s technique, an injection of 32.0±6.8 mL methylene blue resulted in a maximal pressure of 85.3±9.5 cmH2O in the CBD. When BL formed at minor bile ducts and surrounding the ligation sites, the pressures in CBD were 25.8± 3.3 and 86.0± 9.9 cmH2O, respectively. One grade A BL occurred in just one of the 54 patients in the research group, compared to 31 (15.0%) of the 206 patients who were recruited in the historical control group. In the control group, there were substantially fewer BL found by the standard white gauze test than in the study group (Z=-3.002, P=0.003). Following PSM, the incidence of grade B/C BL and BL in the control group was respectively 20.4% and 11.1%. In the research group, the equivalent occurrences were 1.9% (χ2 = 7.594, P=0.006) and 0% (P=0.027), respectively. The research group’s hospital stay was considerably cut short (Z=-6.048, P<0.001)

Peng’s test for intraoperative BL identification reduced BL following hepatectomy and is both secure and efficient.

Reference: sciencedirect.com/science/article/abs/pii/S1743919122005258