Classification of iatrogenic bile duct injury^[1-3]

Strasberg classification:

Type A – Injury to the cystic duct or from minor hepatic ducts draining the liver bed.
Type B – Occlusion of biliary tree, commonly aberrant right hepatic duct(s).
Type C – Transection without ligation of aberrant right hepatic duct(s).
Type D – Lateral injury to a major bile duct.
Type E (1-5) – Circumferential injury to the main hepatic duct; classified according to level of injury:
- E1 (Bismuth type 1) – Injury more than 2 cm from confluence
- E2 (Bismuth type 2) – Injury less than 2 cm from confluence
- E3 (Bismuth type 3) – Injury at the confluence; confluence intact
- E4 (Bismuth type 4) – Destruction of the biliary confluence
- E5 (Bismuth type 5) – Combined with injury to aberrant right hepatic duct

References:

Strasberg, SM, Hertl, M, Soper, NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101.
Bismuth, H, Lazorthes, F. Les traumatismes operatoires de la voie biliare principale. Paris, France: Masson, 1981.
Chartrand-Lefebvre, C, Dufresne, M-P, Lafortune, M, et al. Iatrogenic injury to the bile duct: A working classification for radiologists. Radiology 1994; 193:523.

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Classification of iatrogenic bile duct injury[1-3]