Iatrogenic bile duct injuries: Etiology, diagnosis and management

Table 1 Main causes of benign biliary strictures

Congenital strictures	Biliary atresia and congenital cysts
Bile duct injuries	Iatrogenic: postoperative, following endoscopic and percutaneous procedures
	Following blunt or penetrating trauma of the abdomen
Inflammatory strictures	Cholelithiasis and choledocholithiasis
	Mirizzi’s syndrome
	Chronic pancreatitis
	Chronic ulcer or diverticulum of the duodenum
	Abscess or inflammation of the liver or subhepatic region
	Parasitic, viral infection
	Toxic drugs
	Recurrent pyogenic cholangitis
	Primary sclerosing cholangitis
	Radiation-induced strictures
	Papillary stenosis

Table 2 Incidence of IBDI following cholecystectomy (%)

Author	IBDI incidence following OC	IBDI incidence following LC
McMahon et al[14], 1995	0.2	0.81
Strasberg et al[15], 1995	0.7	0.5
Shea et al[16], 1996	0.19-0.29	0.36-0.47
Targarona et al[17], 1998	0.6	0.95
Lillemoe et al[18], 2000	0.3	0.4-0.6
Gazzaniga et al[19], 2001	0.0-0.5	0.07-0.95
Savar et al[20], 2004	0.18	0.21
Moore et al[21], 2004	0.2	0.4
Misra et al[22], 2004	0.1-0.3	0.4-0.6
Gentileschi et al[23], 2004	0.0-0.7	0.1-1.1
Kaman et al[24], 2006	0.3	0.6

IBDI: Iatrogenic bile duct injuries; OC: Open cholecystectomy; LC: Laparoscopic cholecystectomy.

Table 3 Terblanche clinical classification for assessment of long-term results of surgical bile duct repair

Grade	Result
I	Excellent	No biliary symptoms with normal liver function
II	Good	Transitory symptoms, currently no symptoms and normal liver function
III	Fair	Clearly related symptoms requiring medical therapy and/or deteriorating liver function
IV	Poor	Recurrent stricture requiring correction, or related death