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Classification of iatrogenic bile duct injury |
Wan-Yee Lau and Eric C.H. Lai |
Hong Kong, China
Author Affiliations: Department of Surgery, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China (Lau WY and Lai ECH)
Corresponding Author: Wan-Yee Lau, MD, Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China (Tel: 852-2632 2626; Fax: 852-2637 7974; Email: josephlau@cuhk.edu.hk) |
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Abstract BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury.
DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords “bile duct injury”, “cholecystectomy”, and “classification”. Additional papers were identified by a manual search of the references from the key articles.
RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classification made Bismuth’s classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification.
CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.
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