The selective nerve stain leucomethylene blue as an intraoperative aid to achieving complete vagotomy

Abstract

SUMMARYThe recently reported vagal nerve stain leucomethylene blue was assessed in 20 patients as an intraoperative aid to attaining complete vagotomy. Of 101 stained specimens removed at surgery, only 30 (30%) contained nerve tissue. Four of 17 postoperative insulin tests were positive by Hollander's criteria. The dye technique was found to be an unreliable method of ensuring complete vagotomy at the time of surgery.Due to the high incidence of incomplete vagotomy (Davies, 1956;Ross and Kay, 1964;Johnston, Thomas, Checketts, and Duthie, 1967) there is a need for a simple and reliable intraoperative method for achieving complete vagal section. Lee (1969) recently described a selective nerve stain, leucomethylene blue', which he claimed reliably stained small vagal fibres. The present report describes our experience with the dye in 20 patients. Material and MethodsFor this study 20 patients undergoing vagotomy for peptic ulcer disease were selected at random over a three-month period. The operations were performed by 14 different surgeons but the stain was applied and the specimens removed in each instance by one of the authors (M.L.F.).The technique employed was similar to that described by Lee with the exception that the left gastric artery was not divided. After dissection of the peritoneum and division of both main vagal trunks, leucomethylene blue was applied to the bared anterior and posterior surfaces of the oesophagus using a cotton swab. Considerable

Leucomethylene blue staining during vagotomy

“…Lee reported that 80 per cent of the coloured removed twigs contained nerve tissue. Lee's study was confirmed by H0j and Wolf in 1972 (2) in an experimental study with rabbit vagal nerve twigs, but other authors (3,4) found that only 30 per cent of coloured specimens contained nerves. A controlled study published by Jensen et al in 1971 (5) found no difference in the postoperative reduction in fasting and basal acid output between a control group and a group of patients in which the LMB technique had been used.…”

Cellular and molecular actions of Methylene Blue in the nervous system

“…However, it selectively stains certain subpopulations of neurons in the brain, e.g. cerebellar Purkinje cells, where it binds to their dendritic spines (Müller, 1992) or polymorphic nerve cells in the hippocampal cornu ammonis, after supra-vital (intracardiac injection in deeply anesthetized animals) administration (Müller, 1998) and has been employed routinely for the staining of neuronal structures in clinical and histochemical studies (Frimer et al, 1970; Kristiansen, 1989; Müller, 1990; 1998; Seif et al, 2004). At the ultrastructural level, it was shown that MB appears as electron-dense precipitates staining the cytoplasm and chromatin homogeneously.…”

Five- to Eight-year Results of Truncal Vagotomy and Pyloroplasty for Duodenal Ulcer

“…Lee (1969) introduced a method of applying a solution of leucomethylene blue to the outer aspect of the lower oesophagus at operation and alleged that the dye selectively stained nerve tissues, thus facilitating recognition of vagal strands during vagotomy. But others have not been impressed by its reliability or usefulness (Cox and Cooke, 1970;Frimer et al, 1970). Grassi (1971) designed a test which attempts to assess the completeness of vagotomy during the operation by determining the acidity of the mucosal surface before and after the nerve section by means of a pH probe.…”