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Invited Critique
April 2008

The White Test: A New Dye Test for Intraoperative Detection of Bile Leakage During Major Liver Resection—Invited Critique

Arch Surg. 2008;143(4):404. doi:"10.1001/archsurg.143.4.404

Nadalin and 8 coauthors from Essen, Germany, have described an intraoperative technique to localize bile leakage from the hepatic parenchymal surface using a cystic duct injection of fat emulsion, 5%. This technique, previously described to detect urinary leakage after renal transplantation, has allowed the authors to identify bile leakages in 74% of their patients. Once identified and sutured, a postoperative biliary leak rate of 5.1% was reported. This incidence is lower than the authors' previously published leakage rate of 8% in more than 1600 hepatic resections, though a statistical comparison is not included.

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