Is a cholecystectomy always necessary for a bile leakage test after hepatic surgery?

I read with interest the article by Guillaud et al. and their valuable efforts in identifying the risk factors of bile leakage after a major liver resection.¹ I completely agree with their conclusion that the incidence of post-hepatectomy biliary leakage could be reduced by performing a blue dye test in all resections although the methylene blue test was performed only in half of their patients. They suggested that a dye test requires a cholecystectomy which is not always necessary in lesser resections. However, a cholecystectomy for a bile leakage test is not mandatory as placement of a fine angiocath catheter directly into the common bile duct serves both for a bile leakage test² and a cholangiography.³

I have used routine bile leakage testing in hydatid liver cyst surgery² without the need for a cholecystectomy in most patients by means of a 22-G venous catheter passed through the anterior wall of the common bile duct. After occluding the distal part of the common bile duct with a sling, normal saline (or methylene blue) was injected slowly into the intrahepatic bile ducts. Any visualized biliary orifices were sutured. After catheter removal, the resulting defect is sutured with 6/0 polyglycolic acid. This technique was used in more than 25 cases without any major complication and with a very high success rate. This technique also eliminated the failure risk of a transcystic approach if there is a low confluence of the cystic and common hepatic duct. A cholecystectomy is therefore not essential for this test.