ArticleJournal of the American College of Surgeons2013
Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications.
Article in Journal of the American College of Surgeons, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 76 citations in OpenAlex.
- Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022.World journal of surgery · 2023Pooled it
- Evaluation of the white test effectiveness for the prevention of bile leakage after liver resection: multicenter randomized controlled study.Updates in surgery · 2025Trial
- Trial
- A novel bile leak test using contrast-enhanced intraoperative ultrasonic cholangiography in liver resection: a prospective single-arm trial.Surgical endoscopy · 2026Article
- Efficacy of preoperative endoscopic nasobiliary drainage tube placement for liver cancer adjacent to the hepatic hilum.Langenbeck's archives of surgery · 2025Article
- Review
- Risk-stratified posthepatectomy pathways based upon the Kawaguchi-Gayet complexity classification and impact on length of stay.Surgery open science · 2022Article
- Clinical impact of intraoperative bile leakage during laparoscopic liver resection.Surgical endoscopy · 2021Article
- Article
- Variation in Drain Management Among Patients Undergoing Major Hepatectomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Article
- Short- and Long-Term Outcomes of a Transdiaphragmatic Approach for Simultaneous Resection of Colorectal Liver and Lung Metastases.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Article
- Comparison of Outcomes After Primary Laparoscopic Versus Open Approach for T1b/T2 Gallbladder Cancer.Frontiers in oncology · 2021Article
- Authors' Reply: Bile Leak Reduction with Laparoscopic Versus Open Liver Resection: A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis.World journal of surgery · 2020Article
- Bile Leak Reduction with Laparoscopic Versus Open Liver Resection: A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis.World journal of surgery · 2020Article
- Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies.Annals of surgery · 2020Article
- Article
- Impact of epidural analgesia on the systemic biomarker response after hepatic resection.Oncotarget · 2019Article
- Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2018Article
- Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2018Article
- Hydrogen peroxide test for intraoperative bile leak detection.Medical journal, Armed Forces India · 2017Article
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Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundAfter hepatectomy, bile leaks remain a major cause of morbidity, cost, and disability. This study was designed to determine if a novel intraoperative air leak test (ALT) would reduce the incidence of post-hepatectomy biliary complications. STUDY
designRates of postoperative biliary complications were compared among 103 patients who underwent ALT and 120 matched patients operated on before ALT was used. All study patients underwent major hepatectomy without bile duct resection at 3 high-volume hepatobiliary centers between 2008 and 2012. The ALT was performed by placement of a transcystic cholangiogram catheter to inject air into the biliary tree, the upper abdomen was filled with saline, and the distal common bile duct was manually occluded. Uncontrolled bile ducts were identified by localization of air bubbles at the transection surface and were directly repaired.
resultsThe 2 groups were similar in diagnosis, chemotherapy use, tumor number and size, resection extent, surgery duration, and blood loss (all, p > 0.05). Single or multiple uncontrolled bile ducts were intraoperatively detected and repaired in 62.1% of ALT vs 8.3% of non-ALT patients (p < 0.001). This resulted in a lower rate of postoperative bile leaks in ALT (1.9%) vs non-ALT patients (10.8%; p = 0.008). Independent risk factors for postoperative bile leaks included extended hepatectomy (p = 0.031), caudate resection (p = 0.02), and not performing ALT (p = 0.002) (odds ratio = 3.8; 95% CI, 1.3-11.8; odds ratio = 4.0; 95% CI, 1.1-14.3; and odds ratio = 11.8; 95% CI, 2.4-58.8, respectively).
conclusionsThe ALT is an easily reproducible test that is highly effective for intraoperative detection and repair of open bile ducts, reducing the rate of postoperative bile leaks.
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