title: Bile leakage test in liver resection: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess systematically the safety and efficacy of bile leakage test in liver resection.
  
  
  METHODS
  Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate postoperative bile leakage, intraoperative positive bile leakage, and complications. We used either the fixed-effects or random-effects model.
  
  
  RESULTS
  Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection. The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group (RR = 0.39, 95%CI: 0.23-0.67; I (2) = 3%). The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test (RR = 2.38, 95%CI: 1.24-4.56, P = 0.009). No significant intergroup differences were observed in total number of complications, ileus, liver failure, intraperitoneal hemorrhage, pulmonary disorder, abdominal infection, and wound infection.
  
  
  CONCLUSIONS
  The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications. Fat emulsion is the best choice of solution for the test.
authors.affiliation: Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Hai-Qing
authors.initials: HQ
authors.lastname: Wang
authors.affiliation: Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology; D016009:Chi-Square Distribution; D003938:Diagnostic Techniques, Digestive System; D005217:Fat Emulsions, Intravenous; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green; D008751:Methylene Blue; D016017:Odds Ratio; D011237:Predictive Value of Tests
chemical_list: D005217:Fat Emulsions, Intravenous; D007208:Indocyanine Green; D008751:Methylene Blue
keywords: Bile leakage; Bile leakage test; Liver resection; Meta-analysis; Postoperative complications