Lazzarotto-DA-Silva Gabriel, Grezzana-Fiilho Tomaz de Jesus Maria, Leipnitz Ian, Feier Flávia Heinz, Rodrigues Pablo Duarte, Hallal Celina Pereira, Chedid Marcio Fernandes, Kruel Cleber Rosito Pinto
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Liver Transplant and Hepatobiliary Surgery - Porto Alegre (RS), Brazil.
Universidade Federal do Rio Grande do Sul, Post-Graduate Program in Surgical Sciences - Porto Alegre (RS), Brazil.
Arq Bras Cir Dig. 2025 Apr 7;38:e1876. doi: 10.1590/0102-6720202500007e1876. eCollection 2025.
Biliary fistula is one of the most common complications after liver resection and is associated with significant morbidity and mortality. One of the methods used to evaluate biliary fistulas is the White test, which consists of injecting a lipid emulsion into the bile duct. However, no standard technique for performing the White test has been published.
The aim of this study was to standardize the technique for performing the White test in patients undergoing hepatectomies, with and without previous cholecystectomy, and to assess the preliminary results.
Patients over 18 years of age who were submitted to open hepatectomy were included in the study. The primary outcome was the rate of biliary fistula. Secondary outcomes were the incidence of acute pancreatitis and overall morbidity, measured by the Clavien-Dindo classification.
The standard technique for the White test was performed on 17 patients. In total, three patients had previous cholecystectomy, and two had low insertion of the cystic duct, requiring cannulation of the hepatocholedochal duct. None of the patients developed clinically significant biliary leaks. Acute pancreatitis did not occur in any patient. One patient developed pneumonia requiring mechanical ventilation (Clavien-Dindo IV). All others had minor or no complications.
The standardized technique for performing the White test suggests an appropriate strategy to maximize the detection of intraoperative biliary leaks.
胆瘘是肝切除术后最常见的并发症之一，与较高的发病率和死亡率相关。评估胆瘘的方法之一是怀特试验，该试验包括向胆管内注入脂质乳剂。然而，尚未发表关于进行怀特试验的标准技术。
本研究的目的是规范在接受肝切除术的患者中进行怀特试验的技术，无论患者之前是否接受过胆囊切除术，并评估初步结果。
本研究纳入了18岁以上接受开放性肝切除术的患者。主要结局是胆瘘发生率。次要结局是急性胰腺炎的发生率和总体发病率，采用Clavien-Dindo分类法进行测量。
对17例患者进行了怀特试验的标准技术操作。总共有3例患者之前接受过胆囊切除术，2例患者胆囊管低位插入，需要对肝总管进行插管。所有患者均未发生具有临床意义的胆漏。所有患者均未发生急性胰腺炎。1例患者发生肺炎，需要机械通气（Clavien-Dindo IV级）。所有其他患者均有轻微并发症或无并发症。
进行怀特试验的标准化技术提示了一种适当的策略，可最大限度地检测术中胆漏。
