Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery
DOI:
https://doi.org/10.3889/oamjms.2021.6008Keywords:
Bismuth classification, Bile duct injury, Cholecystectomy, MortalityAbstract
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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Copyright (c) 2020 Budhi Ida Bagus, Metria Ida Bagus, Setyawati Ida Ayu (Author)
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This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)
