Edorium Journal of Surgery, Vol. 5; 2018. Edorium J Surg 2018;5:100031S05AH2018. www.edoriumjournalofsurgery.com Hassan et al. 1 CASE REPORT OPEN ACCESS Intraoperative trans-cholecystic methylene blue injection for delineation of extrahepatic biliary tree during laparoscopic cholecystectomy Ahmed Mohamed Abdelaziz Hassan, Mohamed Emad Esmat, Hussam Hamdy, Mohamed Abdo, Magdy Elsebae 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 Ahmed Mohamed Abdelaziz Hassan 1 , Mohamed Emad Es- mat 2 , Hussam Hamdy 1 , Mohamed Abdo 3 , Magdy Elsebae 2 Affiliation: 1 Associate Professor of General Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, Egypt; 2 Pro- fessor of General Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak- Elhadar, Imbaba, Giza, Egypt; 3 Assistant Lecturer of Gen- eral Surgery, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, Egypt. Corresponding Author: Ahmed Mohamed Abdelaziz Hassan, General Surgery Department, Theodor Bilharz Research Institute, Kornish El-Nile, Warak-Elhadar, Imbaba, Giza, 12411, Egypt; Email: ahmedelmaghney@yahoo.com Received: 30 July 2018 Accepted: 25 September 2018 Published: 25 October 2018 (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 cholecys- tectomy, Methylene blue 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. Article ID: 100031S05AH2018 ********* doi: 10.5348/100031S05AH2018OA INTRODUCTION Laparoscopic cholecystectomy (LC) is “gold standard” surgical management of symptomatic gallstones. ORIGINAL ARTICLE PEER REVIEWED | OPEN ACCESS