# STANDARDIZATION OF THE WHITE TEST IN OPEN LIVER RESECTION: TOWARD NEAR-ZERO CLINICALLY SIGNIFICANT BILE LEAKAGE

## TL;DR

This study standardizes the White test during liver surgery to reduce bile leakage complications, showing promising results with no significant leaks in tested patients.

## Contribution

The paper introduces a standardized technique for the White test to detect biliary leaks during liver resections.

## Key findings

- None of the 17 patients developed clinically significant biliary leaks using the standardized White test.
- Acute pancreatitis did not occur in any patient, and only one had a severe complication (pneumonia requiring ventilation).
- The standardized technique appears effective for detecting intraoperative biliary leaks.

## Abstract

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.