Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery

Budhi Ida Bagus; Metria Ida Bagus; Setyawati Ida Ayu

doi:10.3889/oamjms.2021.6008

Authors

Budhi Ida Bagus Department of Surgery, Sebelas Maret University, Surakarta, Indonesia https://orcid.org/0000-0002-0310-7415
Metria Ida Bagus Department of Surgery, Medical Faculty, Sebelas Maret University, Surakarta, Indonesia
Setyawati Ida Ayu Department of Surgery, Medical Faculty, Sebelas Maret University, Surakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.6008

Keywords:

Bismuth classification, Bile duct injury, Cholecystectomy, Mortality

Abstract

BACKGROUND: The incidence rate of bile duct injury (BDI) has not been changed for many years for both open and laparoscopic technique. Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically. Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death. From initial classification published by Bismuth, there have been many classifications of common BDI. We would report the 30 days mortality rate following reconstruction after BDI according to type of Bismuth classification.

AIM: We aimed to present cases of bile duct injury (BDI).

RESULTS: Seven cases of common BDI were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intraoperative cholangiography performed. The most common BDI was Bismuth Type II and IV (2 patients in each type). Reconstruction has been done by hepaticojejunostomy for Type III and IV. Choledochoduodenostomy bypass was done for Types I and II. Two patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow-up. Four others patients could survive with no intra-abdominal complication nor other morbidity.

CONCLUSION: Bismuth classification was the simplest way to describe the BDI, Bismuth Type IV was associated with the higher risk of 30 days mortality rate.

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