INTRAOPERATIVE ASSESSMENT OF BILIARY ANATOMY FOR PREVENTION OF BILE DUCT INJURY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Abstract: Introduction & Aim of work: Bile duct injury (BDI) is a dreaded complication of laparoscopic 
cholecystectomy, often caused by misinterpretation of biliary anatomy. To prevent BDI, many techniques 
have been developed for intraoperative assessment of bile duct anatomy. Biliary tree injuries may be 
decreased by direct coloration of the gall bladder, the cystic duct, and CBD. 
Methods: gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same 
amount of 50% methylene blue diluted by saline solution was injected into the gall bladder for coloration of 
biliary tree. The dissection of Calot’s triangle was much more safely performed after blue coloration of the gall 
bladder, cystic duct and CBD. 
Results: 48 patients were operated on (39 females and 9 males), methylene blue dye succeeded to paint the 
biliary tree in 42 patients (87.5 %). In 6 patients (12.5%) there were no free passages of the dye to the CBD 
because gall bladders were filled with stones, gall bladders were occluded by a large stone at Hartman’s 
pouch, or gall bladder had very thick wall. There were no patients with BDI. 
Conclusion: The number of bile duct injuries related to anatomic misidentification can be decreased and even 
vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.