AI Article Synopsis
- Bile duct injuries (BDIs) are common during laparoscopic cholecystectomy and the ATOM classification effectively addresses all aspects of such injuries, including anatomy, timing, and mechanisms of damage.
- From 2008 to 2016, a study involving 26 patients revealed that most injuries were to the main bile duct, and the ATOM classification outperformed other classification systems in comprehensively addressing these injuries.
- The study underscores the need for specialized referral centers to manage the complex cases of BDIs, highlighting the importance of a thorough classification for better prevention and treatment strategies.
Article Abstract
Purpose: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC.
Methods: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis.
Results: Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover).
Conclusions: The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.
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| http://dx.doi.org/10.1089/lap.2018.0413 | DOI Listing |
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