Bile leakage test in hepatectomy is better when it bubbles

Background: Liver resection is the only potentially curative treatment for liver tumors. Billiary fistulas remains a major concern in hepatectomies and its incidences has not changed over the past few decades. Many methods have been suggested to prevent bile leakage without a significance acceptance. Aim: Assess whether the systematic use of the bile leakage test during liver resections reduces the incidence of biliary fistula in the postoperative period. Materials and Methods: From December 2016 to February 2020, sixty-two hepatectomies performed using bile leakage test were prospectively analyzed to compare the incidence of biliary fistula in patients that had a negative bile leak test (group A) and patients that had a positive test (group B). The bile leak test was performed after liver transection, by injection of 10 mL of saline solution in the cystic duct, through a cholangiography catheter followed by 10 ml of air twice. Leaking points were sutured with 5-0 monofilament polypropylene. Results: Twenty-seven patients (46%) were allocated to group A and thirty-two patients (54%) were allocated to group B. Three patients were excluded from analysis. Three patients (5%) evolved with biliary fistula in the postoperative period, two from the group A and one from group B, with no significant difference (p = 0.45). Conclusion: In conclusion, the bile leakage test proposed in the present study proved to be safe, with no complications related to the test. Even though there was no significant difference in the number of patients that evolved with fistula between the analyzed groups, results suggest that the majority of patients with a positive test may have benefited from the exam and did not developed biliary fistula. Further studies, with a larger group of patients, are necessary to corroborate this statement.