Hydrogen peroxide test for intraoperative bile leak detection

Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively. Topical application of 1.5% diluted hydrogen peroxide (H₂O₂) was used to detect the BL from cut surface of liver and we compared this with conventional saline method to know the efficacy.

A total of 31 patients included all patients who underwent liver resection and donor hepatectomies as part of Living Donor Liver Transplantation. After complete liver resection, the conventional saline test followed by topical diluted 1.5% H₂O₂ test was performed on all.

A BL was demonstrated in 11 patients (35.48%) by the conventional saline method and in 19 patients (61.29%) by H₂O₂ method. Statistically compared by Wilcoxon signed-rank test showed significant difference (P = 0.014) for minor liver resections group and (P = 0.002) for major liver resections group.

The topical application of H₂O₂ is a simple and effective method of detection of BL from cut surface of liver. It is an easy, non-invasive, cheap, less time consuming, reproducible, and sensitive technique with no obvious disadvantages.