Περίληψη:
Several studies seem to indicate at least a 2-fold increase in bile duct
injuries (BDI) since the inception of laparoscopic cholecystectomy.
Moreover, injuries seem to be more proximal, seem to be revealed
earlier, are expressed by leaks more often than by strictures, are
repaired more frequently by nonspecialists (either during the index
operation or soon after), and appear to be more often associated with
loss of substance and ischemia. The plethora of prior classifications
probably attests to the evolving clinical spectrum, the mounting wealth
of ever-increasing diagnostic methods, and an acknowledgment of
insufficiencies or lack of data in earlier classification reports.
Previous attempts at uniformity remain incomplete. The purpose of this
study was to devise a nominal classification, combining all existing
classification items, taking into account the changing pattern of BDI.
Extensive bibliographic research, analysis of each category within the
individual classifications combined into one uniform classification.
Fifteen classifications were retained. All items were integrated into
the European Association for Endoscopic Surgery (EAES) classification,
using semantic connotations, grouped in three easy-to-remember
categories, A (for anatomy), To (for time of), M (for mechanism): (1)
the anatomic characteristics of the injury: NMBD for non-main bile duct
or MBD for main bile duct (followed by a number 1-6, corresponding to
the anatomic level on the MBD), followed by Oc (for occlusion) or D
(division), P (partial) or C (complete), LS (loss of substance), VBI
(vasculobiliary injury in general), and whenever known, the vessel; (2)
time of detection: Ei (early intraoperative), Ep (early postoperative)
or L (late); and (3) mechanism of injury: Me (mechanical) or ED
(energy-driven).
The EAES composite, all-inclusive, nominal classification ATOM
(anatomic, time of detection, mechanism) should allow combination of all
information on BDI, irrespective of the original classification used,
and thus facilitate epidemiologic and comparative studies; indicate
simple, appropriate preventive measures; and better guide therapeutic
indications for iatrogenic BDI occurring during cholecystectomy.
Συγγραφείς:
Fingerhut, A.
Dziri, C.
Garden, O. J.
Gouma, D.
Millat,
B.
Neugebauer, E.
Paganini, A.
Targarona, E.
