title: Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection.
abstract: BACKGROUND
  Bile leakage is a common complication of hepatectomy, and is associated with an increase in sepsis and liver failure. There are no standard preventive methods against bile leakage after hepatic surgery. The aim of the present randomized clinical trial was to evaluate the application of indocyanine green (ICG) fluorescent cholangiography for preventing postoperative bile leakage.
  
  
  METHODS
  102 patients who underwent hepatic resection without biliary reconstruction were divided into 2 groups. The control group (n = 50) underwent a leak test with ICG dye alone, and the experimental group underwent a leak test with ICG dye, followed by ICG fluorescent cholangiography using the Photodynamic Eye (PDE group, n = 52).
  
  
  RESULTS
  Among 42 patients with fluorescence in the PDE group, 25 patients had insufficient closure of bile ducts on the cut surface of the liver, which were closed by suture or ligation. There were 5 patients who developed postoperative bile leakage in the control group versus no bile leakage in the PDE group (10% vs 0%, P = .019).
  
  
  CONCLUSIONS
  ICG fluorescent cholangiography could detect insufficiently closed bile ducts that could not be identified by a standard bile leak test. ICG fluorescent cholangiography may have useful potential for prevention of bile leakage after hepatic resection.
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka 573-1191, Japan. kaibori@hirakata.kmu.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.forename: A Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology; D001646:Bile / Q000502:physiology; D001652:Bile Ducts / Q000601:surgery; D002758:Cholangiography / Q000379:methods; D005260:Female; D005456:Fluorescent Dyes; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000517:prevention & control
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green