From the Guidelines
Prolapsed bile is classified as Grade B in the Bismuth-Strasberg classification system for bile duct injuries. This grading system specifically categorizes bile duct injuries that occur during cholecystectomy procedures. Grade B refers to a lateral injury to the biliary tree with a resultant bile leak, without complete transection of the duct. This typically presents as bile leakage from small ducts in direct communication with the main biliary system. Management usually involves endoscopic retrograde cholangiopancreatography (ERCP) with stent placement to divert bile flow and allow the leak to heal, as recommended by the 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy 1. The classification is important for determining appropriate treatment strategies and predicting outcomes. Patients with Grade B injuries generally have better prognoses than those with complete transection injuries, as the continuity of the biliary system remains intact, facilitating easier repair and recovery.
Some key points to consider in the management of bile duct injuries include:
- The use of adjuncts for biliary tract visualization, such as IOC or ICG-C, to increase the rate of intraoperative diagnosis 1
- The consideration of direct repair with or without T-tube placement for minor BDIs, and hepaticojejunostomy for major BDIs 1
- The importance of early referral to a center with expertise in HPB procedures for major BDIs diagnosed in the immediate postoperative period 1
- The use of percutaneous drainage, targeted antibiotics, and nutritional support for major BDIs diagnosed between 72 h and 3 weeks, with consideration of ERCP and PTBD to reduce the pressure gradient in the biliary tree 1
Overall, the management of prolapsed bile, or Grade B bile duct injuries, requires a multidisciplinary approach and careful consideration of the patient's individual needs and circumstances, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Bile Duct Injury Classification
The classification of bile duct injuries is crucial for determining the appropriate treatment approach.
- The Bismuth classification is a commonly used method for grading bile duct injuries, which is based on the distance of the injury from the biliary confluence 2.
- The Bismuth classification has been shown to be an accurate and practical method for grading postoperative bile duct lesions with cholangiography, with an exact correspondence between cholangiographic and surgical findings in 85% of cases 2.
- The classification system includes five types of injuries: Type A, Type B, Type C, Type D, and Type E, with Type A being the least severe and Type E being the most severe.
Prolapsed Bile Duct Injury
Regarding prolapsed bile duct injury, there is limited information available in the provided studies.
- However, it can be inferred that prolapsed bile duct injury may be classified using the Bismuth classification system, which takes into account the location and severity of the injury.
- The Bergman classification is another system used to classify postoperative biliary tract lesions, which includes five types of injuries: Type A, Type B, Type C, Type D, and Type E 3.
- In the study by 3, the type of postoperative lesion was classified using the Bergman classification, with five patients having Type C, three having Type D, one having Type B, and one having Type A.
Diagnostic Techniques
Various diagnostic techniques are used to evaluate bile duct injuries, including: