Can bile duct injuries be prevented? "A new technique in laparoscopic cholecystectomy"

gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus.Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury.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.Laparoscopic cholecystectomy (LC) is considered as the "golden standard" in the surgical management of symptomatic cholelithiasis. Short hospitalisation period and rapid return to normal activity, less post-operative pain, more acceptable cosmetic results and lesser morbidity and mortality rates, are the principle advantages of this technique. However, the incidence of bile duct injuries is two times greater when compared to open cholecystectomy [1-11]. Bile duct injury, either in classic open or laparoscopic cholecystectomy, may