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Original Article
Intraoperative trans-cholecystic methylene blue injection for delineation of extrahepatic biliary tree during laparoscopic cholecystectomy
1 Associate Professor of General Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, Egypt
2 Professor of General Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, Egypt
3 Assistant Lecturer of General Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, Egypt
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Ahmed Mohamed Abdelaziz Ha
General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, 12411,
Egypt
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Article ID: 100031S05AH2018
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How to cite this article
Hassan AMA, Esmat ME, Hamdy H, Abdo M, Elsebae M. Intraoperative trans-cholecystic methylene blue injection for delineation of extrahepatic biliary tree during laparoscopic cholecystectomy. Edorium J Surg 2018;5:100031S05AH2018.ABSTRACT
Aims: The incidence of bile duct injury in laparoscopic cholecystectomy is double greater compared to classic open surgery. Cholecysto-cholangiography technique had been suggested as a substitute to cystic duct cholangiography because it is easy, safe and successful. The aim of this work was to assess safety, effectiveness and feasibility of trans-cholecystic Methylene Blue (MB) injection for better delineation of extra hepatic biliary ducts and proper assessment of biliary anatomy.
Methods: Fifty patients with chronic calcular cholecystitis who are candidates for laparoscopic cholecystectomy were recruited for the study. During the procedure all the bile in the gall bladder was aspirated and diluted MB equal to the amount of aspirated bile was injected slowly into the gall bladder. Intra-peritoneal spillage of MB, surgical time, post-operative complications, in addition to the clear anatomical delineation of extra-hepatic biliary radicles was documented.
Results: 45 patients (90%) were females, while five patients (10%) of them were males, with a mean age of 34.6±13.74 years. By using this technique all gall bladders, 48 cystic ducts, and 42 common bile ducts were painted. The mean operative time was 78.63 ± 12.37 minutes and the mean hospital stay was 1.13±0.43 days.
Conclusion: The intraoperative injection of methylene blue into the gall bladder fundus during laparoscopic cholecystectomy for direct visualization of the gall bladder, cystic duct and common bile duct is a feasible, cheap and easy maneuver without any radiation exposure or special equipments. This technique is proposed as an optional method in case of dissection difficulty of Calot’s triangle during laparoscopic cholecystectomy to decrease the main cause of biliary injury.
Keywords: Cystic duct, Laparoscopic cholecystectomy, Methylene blue
SUPPORTING INFORMATION
Author Contributions:
Ahmed Mohamed Abdelaziz Ha - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed Emad Esmat - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hussam Hamdy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed Abdo - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Magdy Elsebae - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this study.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Ahmed Mohamed Abdelaziz Hassan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
