Intraoperative bile leakage detection during liver surgery using propofol

Background

Advances in surgical technique and postoperative management have significantly reduced morbidity and mortality rates during liver surgery. However, bile leakage remains a common complication after major liver surgery, increasing morbidity, hospital stay and cost.¹ During the last decade, many intraoperative tests have been reported to help identify and manage bile leakage.^2,3

Technique

At the end of the procedure, a 18G venous catheter is inserted through the common bile duct or the cystic duct stump if a cholecystectomy was performed. The distal common bile duct is either occluded manually or with the use of a vessel loop. 5–10ml of propofol 1% is injected slowly into the biliary tree with a syringe. With propofol being a milk-like solution, if any leakage is present, white fluid will be visualised on the surgical margin. All detected open bile ducts are closed with a polydioxanone suture. The surgical site is washed off with sterile saline and the test is repeated if necessary. At the end of the test, any residual propofol in the biliary tree is washed away with sterile saline and the catheter insertion site is closed with a polydioxanone suture.

Discussion

Intraoperative detection of bile leakage during liver surgery using propofol is based on the White test.⁴ Instead of using fat emulsion, we prefer using propofol, which is also a fat soluble, white preparation, readily available in any operating theatre. We have successfully used propofol intraoperatively for bile leakage detection during major liver resections and hydatid liver cyst surgery with no adverse effects.