A 55-year-old jaundiced patient has a hilar cholangiocarcinoma. MRI/MRCP shows bilateral hepatic duct involvement extending to the second-order ducts on the right and first-order duct on the left, with right portal vein involvement. What is the Bismuth–Corlette classification?

• A Type II
• B Type IIIb
• C Type IV
• D Type IIIa ✓

Explanation

The Bismuth–Corlette classification: Type I = CHD below confluence; II = involves confluence; IIIa = extends to right second-order ducts; IIIb = extends to left second-order ducts; IV = bilateral second-order ducts or multifocal. Right portal vein involvement does not change the Bismuth type but impacts resectability. Extension to second-order right hepatic ducts with first-order left involvement = Type IIIa.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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