Use of Methylene Blue Dye During Laparoscopic Cholecystectomy for Mapping of Extrahepatic Biliary Tree

Open Access

Abstract

Background: Laparoscopic cholecystectomy is the standard surgical treatment for symptomatic gallstone disease; however, bile duct injury remains one of the most serious complications. Accurate identification of extrahepatic biliary anatomy is essential for safe surgery. Intraoperative methylene blue dye injection has been proposed as a simple technique to improve visualization of biliary structures. Objective: This study aimed to evaluate the efficacy and safety of methylene blue dye use during laparoscopic cholecystectomy for delineation of extrahepatic biliary tree. Methods & Materials: This quasi-experimental study was conducted in the Department of Surgery, Chattogram Medical College Hospital, over a 12-month period from February 2022 to January 2023. A total of 111 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy were included using convenient sampling. Diluted methylene blue dye was injected intraoperatively into the gallbladder lumen for visualization of biliary anatomy. Patients were followed postoperatively to assess complications. Statistical analysis was performed using SPSS version 25. Results: Mean age of patients was 42.8±12.3 years and 76.6% were female. Chronic cholecystitis was the most common clinical presentation (86.5%). Gallbladder visualization was achieved in 91.0% of cases, cystic duct in 73.0% and common bile duct in 27.0%. Mean operative time was 49.98±11.94 minutes. Postoperative urine discoloration occurred in 7.2% of patients. Mean hospital stay was 1.18±0.39 days. Conclusion: Intraoperative methylene blue dye injection is a feasible, safe and cost-effective method for delineation of extrahepatic biliary anatomy during laparoscopic cholecystectomy. The technique may reduce the risk of bile duct injury and can be useful in settings where advanced imaging modalities are not available.