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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206.
Capussotti L, Polastri R. Operative risks of major hepatic resections. Hepatogastroenterology. 1998;45:184–90.
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–407.
Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–710.
Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg. 1998;133:156–61.
Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al. Bile leakage after hepatic resection. Ann Surg. 2001;233:45–50.
Nagano Y, Togo S, Tanaka K, Masui H, Endo I, Sekido H, et al. Risk factors and management of bile leakage after hepatic resection. World J Surg. 2003;27:695–8.
Terajima H, Ikai I, Hatano E, Uesugi T, Yamamoto Y, Shimahara Y, et al. Effectiveness of endoscopic nasobiliary drainage for postoperative bile leakage after hepatic resection. World J Surg. 2004;28:782–6.
Ijichi M, Takayama T, Toyoda H, Sano K, Kubota K, Makuuchi M. Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg. 2000;135:1395–400.
Rudow DL, Brown Jr RS, Emond JC, Marratta D, Bellemare S, Kinkhabwala M. One-year morbidity after donor right hepatectomy. Liver Transpl. 2004;10:1428–31.
Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg. 2002;195:484–9.
Nakayama H, Masuda H, Shibata M, Amano S, Fukuzawa M. Incidence of bile leakage after three types of hepatic parenchymal transection. Hepatogastroenterology. 2003;50:1517–20.
Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: where is the risk? Arch Surg. 2006;141:690–5.
Rubens FD, Ruel M, Fremes SE. A new and simplified method for coronary and graft imaging during CABG. Heart Surg Forum. 2002;5:141–4.
Taggart DP, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswani L, Pigott DW. Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg. 2003;75:870–3.
Reuthebuch O, Haussler A, Genoni M, Tavakoli R, Odavic D, Kadner A, et al. Intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest. 2004;125:418–24.
Balacumaraswani L, Abu-Omar Y, Choudhary B, Pigott D, Taggart DP. A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. J Thorac Cardiovasc Surg. 2005;130:315–20.
Mitsuhashi N, Kimura F, Shimizu H, Imamaki M, Yoshidome H, Ohtsuka M, et al. Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepatobiliary Pancreat Surg. 2008;15:508–14.
Landsman ML, Kwant G, Mook GA, Zijlstra WG. Light-absorbing properties, stability, and spectal stabilization of indocyanine green. J Appl Physiol. 1976;40:575–83.
Mordon S, Devoisselle JM, Soulie-Begu S, Desmettre T. Indocyanine green: physicochemical factors affecting its fluorescence in vivo. Microvasc Res. 1998;55:146–52.
Mulllock BM, Shaw LJ, Fitzharris B, Peppard J, Hamilton MJ, Simpson MT, et al. Sources of proteins in human bile. Gut. 1985;26:500–9.
Ishizawa T, Tamura S, Masuda K, Aoki T, Hasegawa K, Imamura H, et al. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg. 2009;208:e1–4.
Neuhaus P. Complications of liver surgery and their management. In: Lygidakis NJ, Tytgat GNJ, editors. Hepatobiliary and pancreatic malignancies: diagnosis, medical and surgical management. New York: Thieme-Stratton; 1989. p. 254–9.
Cherrick GR, Stein SW, Leevy CM, Davidson CS. Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest. 1960;39:592–600.
Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150:91–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Electronic Supplementary Materials
Below is the link to the electronic supplementary material.
The areas showing white spots were compressed with gauze, and leakage was tested by additional injection of 3–5 ml of saline (WMV 14,429 kb)
The pattern of fluorescence classified as unconfirmed type (Type D, leakage of dye from the cut surface, but the source was unclear; n = 13/95 patients) (WMV 14,790 kb)
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kaibori, M., Matsui, K., Ishizaki, M., Kon, M. (2015). Detection of Bile Leakage After Hepatic Resection by Intraoperative Indocyanine Green Fluorescent Imaging. In: Dip, F., Ishizawa, T., Kokudo, N., Rosenthal, R. (eds) Fluorescence Imaging for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-319-15678-1_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-15678-1_18
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15677-4
Online ISBN: 978-3-319-15678-1
eBook Packages: MedicineMedicine (R0)