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An educational program developed by the Institute of Image-Guided Surgery of Strasbourg, University of Strasbourg and in partnership with IRCAD.

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Management of bile duct injuries - Endoscopic approach


Introduction


The lesson includes:

Introduction

Video

Quiz

PDF

Speakers

Gianfranco Donatelli

Lesson description:

Multiple classification schemes exist for bile duct injuries (BDI). While the classification by Bismuth and Lazorthes is customary for open surgery, it has been extended by various authors for laparoscopic surgery (such as the Strasberg and Stewart-Way classifications). Recognition of the injury mechanism and extent are essential for a targeted therapy. For endoscopists, the classification by Bergman et al. is customary, including four types of ductal injury: 

  • A: Leakage from cystic duct or peripheral hepatic radicles 
  • B: Major bile duct leakage 
  • C: Isolated duct stricture 
  • D: Complete transection 

When extraluminal rendez-vous procedures are performed by experts, technical success in bile duct reconstruction can reach up to 100%, with a 5-year clinical success rate of 45-68%. Predictive factors for failure are hilar injuries, length of defect/loss of substance, vascular injury, and chronic lesions.