Detection of bile leakage after hepatic resection by intraoperative indocyanine green fluorescent imaging

Abstract

Bile leakage is one of the most common complications after hepatic resection, and is associated with postoperative sepsis and liver failure. However, there are no standard methods of preventing bile leakage after hepatic surgery. We present here the use of indocyanine green (ICG) fluorescent cholangiography for preventing postoperative bile leakage. The subjects were 132 patients who underwent hepatic resection without biliary reconstruction. Patients underwent a leakage test using ICG dye, followed by ICG fluorescent cholangiography using the Photodynamic Eye. Postoperative bile leakage occurred in 7/132 patients (5 %) and persisted for a median period of 6 weeks. The incidence of postoperative bile leakage was 0 % in patients with type A pattern of fluorescence (no fluorescence type: No fluorescence detected on the cut surface of the liver, suggesting absence of bile ducts at the surgical margin; n = 37), 2 % in patients with type B pattern (intact bile duct type: Fluorescence showed one or more intact bile ducts on the cut surface; n = 51), 6 % in patients with type C pattern (injured bile duct type: Leakage of dye from one or more bile duct stumps on the cut surface; n = 31), and 31 % in patients with type D pattern (unconfirmed type: Leakage of dye from the cut surface, but the source was unclear; n = 13). ICG fluorescent cholangiography detected insufficiently closed bile duct stumps that were not identified by the standard bile leakage test. ICG fluorescent cholangiography may be useful for preventing bile leakage after hepatic resection, but patients with type D pattern of fluorescence should be carefully monitored for leakage for several weeks.