title: The White-test helps to reduce biliary leakage in liver resection: a systematic review and meta-analysis.
abstract: BACKGROUND
  Bile leakage testing may help to detect and reduce the incidence of biliary leakage after hepatic resection. This review was performed to investigate the value of the White-test in identifying intraoperative biliary leakage and avoiding postoperative leakage.
  
  
  METHODS
  A systematic review and meta-analysis was performed. Two researchers performed literature research. Primary outcome measure was the incidence of post-hepatectomy biliary leakage; secondary outcome measure was the ability of detecting intraoperative biliary leakage with the help of the White-test.
  
  
  RESULTS
  A total of 4 publications (including original data from our center) were included in the analysis. Evidence levels of the included studies had medium quality of 2b (individual cohort studies including low quality randomized controlled trials). Use of the White-test led to a significant reduction of post-operative biliary leakage [OR: 0.3 (95% CI: 0.14, 0.63), p = 0.002] and led to a significant higher intraoperative detection of biliary leakages [OR: 0.03 (95%CI: 0.02, 0.07), p < 0.00001].
  
  
  CONCLUSIONS
  Existing evidence implicates the use of the White-test after hepatic resection to identify bile leaks intraoperatively and thus reduce incidence of post-operative biliary leakage. Nonetheless, there is a requirement for a high-quality randomized controlled trial with adequately powered sample-size to confirm findings from the above described studies and further increase evidence in this field.
authors: Frankfurt University Hospitals, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany.
authors: Richard
authors: R
authors: Linke
authors: Frankfurt University Hospitals, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany.
authors: Frank
authors: F
authors: Ulrich
authors: Frankfurt University Hospitals, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany.
authors: Wolf O
authors: WO
authors: Bechstein
authors: Frankfurt University Hospitals, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany.
authors: Andreas A
authors: AA
authors: Schnitzbauer
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003938:Diagnostic Techniques, Digestive System; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome