Prevention and Treatment of Perihepatic Fluid Collection Including Two-Step Air Leak Test

Systematic reviews of surgical studies have shown that methylene blue, fat emulsion (with saline flushes), ICG, and air, are all reasonable options to consider, in that they all show a high detection rate of occult leaks (more than 50% of cases) which leads to a decrease in clinical leaks manifesting postoperatively. The “air leak test,” or “air cholangiogram” is a novel bile leak test which reduces both perihepatic fluid collections and bile leaks by testing the transection surface for bubbles underwater. Perhaps its greatest advantage over other bile leak tests is that there is no white, blue, or green mess to clean up or to obscure repeat injections. Based on available data, it is strongly recommended to use a bile leak test when possible to identify occult leaks to prevent clinical leaks from manifesting. Based on level 1 data, routine surgical drains should not be placed for uncomplicated hepatectomies. The air leak test is an easily reproducible bile leak test which is highly sensitive for occult leaks and can facilitate a reduction in routine surgical drain placement.