The utility of 5-aminolevulinic acid-mediated photodynamic diagnosis in the detection of intraoperative bile leakage

Am J Surg. 2017 Jun;213(6):1077-1082. doi: 10.1016/j.amjsurg.2016.09.039. Epub 2016 Oct 8.

Abstract

Purpose: The purpose of this retrospective study was to evaluate the utility of the new intraoperative bile leakage test as a preventive measure of postoperative bile leakage.

Method: 737 patients were retrospectively analyzed with respect to the management of intra- and post-operative bile leakage.

Results: Nine (8.3%) of 109 patients evaluated using conventional white light fluorescent imaging were recognized as having intra-operative bile leakage. However, performance of 5-aminolevulinic acid (5-ALA)-mediated PDD detected bile leakage intraoperatively not only in these 9 patients, but also in an additional 6 patients, such that 'red fluorescence' at the cut surface of the liver, was visualized in a total of 15 patients. The postoperative courses of most patients were uneventful, and postoperative bile leakages occurred in only one (0.9%) patient.

Conclusion: 5-ALA fluorescence imaging may be needed to prevent postoperative bile leakage in patients at high risk for this surgical complication after hepatic resection.

Keywords: 5-Aminolevulinic acid-mediated photodynamic diagnosis; Bile leakage; Hepatic resection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aminolevulinic Acid*
  • Anastomotic Leak / diagnostic imaging*
  • Anastomotic Leak / etiology
  • Bile
  • Child
  • Child, Preschool
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Infant
  • Infant, Newborn
  • Intraoperative Care
  • Intraoperative Complications / diagnostic imaging*
  • Intraoperative Complications / etiology
  • Liver Neoplasms / surgery
  • Male
  • Middle Aged
  • Optical Imaging*
  • Photosensitizing Agents*
  • Retrospective Studies
  • Young Adult

Substances

  • Photosensitizing Agents
  • Aminolevulinic Acid