The Strasberg classification of bile duct injuries after laparoscopic cholecystectomy designates a Type E injury. Which description best matches a Type E4 injury?
- A Injury to an aberrant right sectoral duct
- B Injury involving the confluence of the right and left hepatic ducts (hilar) ✓
- C Circumferential injury to the common hepatic duct below the confluence
- D Cystic duct leak with intact common hepatic duct
Correct answer: B. Injury involving the confluence of the right and left hepatic ducts (hilar)
Explanation
The Strasberg (modified Bismuth) classification of bile duct injuries: E1 = injury >2 cm from confluence; E2 = injury <2 cm from confluence; E3 = injury at the confluence; E4 = injury separating the right and left hepatic ducts (involves the confluence/hilar plate); E5 = injury to aberrant right sectoral duct. Type E4 is the most severe hilar injury involving loss of confluence.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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