McDonald and Terblanche Criteria for Evaluating Hepaticojejunostomy Outcomes
Terblanche Criteria
The Terblanche classification is a validated grading system used to assess long-term outcomes after hepaticojejunostomy for bile duct injury repair. This system categorizes results into distinct grades based on clinical symptoms, biochemical markers, and need for reintervention 1, 2.
Terblanche Grading System:
- Excellent: Asymptomatic with normal liver function tests
- Good: Asymptomatic with mildly abnormal liver function tests, or occasional episodes of cholangitis (≤2 per year) that respond to antibiotics
- Fair: Frequent episodes of cholangitis (>2 per year) requiring antibiotics, or persistently abnormal liver function tests
- Poor: Recurrent stricture requiring reintervention, or development of secondary biliary cirrhosis
Clinical Application:
The Terblanche criteria are specifically used to evaluate patients after biliary reconstruction, particularly following major bile duct injuries requiring hepaticojejunostomy 1. Studies demonstrate that excellent/good Terblanche grades are achieved in approximately 70-85% of patients after hepaticojejunostomy, with comparable outcomes between different surgical techniques 1, 2.
Long-term follow-up using Terblanche criteria is essential because anastomotic strictures can develop months to years after repair, with median time to stricture formation ranging from 11-30 months 3. The stricture rate after hepaticojejunostomy ranges from 10-20% in most series, though rates as high as 69% have been reported 3.
Prognostic Factors:
Factors associated with worse Terblanche outcomes include:
- Associated vascular injury
- Level of bile duct injury
- Sepsis or peritonitis at presentation
- Postoperative bile leakage
- History of major post-transplant complications (in transplant patients) 2
- Male gender (associated with 6.7-fold increased risk of stricture formation) 4
McDonald Criteria
The provided evidence does not contain information about McDonald criteria in the context of hepaticojejunostomy or biliary duct repair outcomes. The McDonald criteria mentioned in medical literature typically refer to diagnostic criteria for multiple sclerosis, which is unrelated to biliary surgery outcomes.
Important Clinical Caveat:
If you are seeking outcome assessment tools for hepaticojejunostomy, the Terblanche classification remains the primary validated system referenced in contemporary hepatobiliary literature 1, 2. Alternative outcome measures include:
- Clavien-Dindo classification for postoperative complications
- Karnofsky performance status for quality of life assessment 1
- Primary patency rates assessed via Kaplan-Meier analysis 2
Long-term Monitoring Strategy:
Following hepaticojejunostomy, patients require:
- Regular imaging surveillance (MRCP or PTC) to detect anastomotic strictures
- Serial liver function tests to identify cholestasis
- Clinical assessment for symptoms of cholangitis (fever, jaundice, abdominal pain)
- Median follow-up of 10+ years is necessary to capture late complications including secondary biliary cirrhosis (2.4-10.9% incidence) 3, 4
Most anastomotic strictures can be successfully managed with percutaneous balloon dilatation (89% success rate), avoiding the need for reoperation in the majority of cases 4, 5.