Following an open cholecystectomy, a patient develops a biliary stricture. Cholangiography shows a stricture of the common hepatic duct located more than 2 cm below the confluence of the right and left hepatic ducts, with both ducts still communicating. According to the Bismuth classification of benign bile duct strictures, what type is this?

• A Bismuth type IV
• B Bismuth type II
• C Bismuth type III
• D Bismuth type I ✓

Explanation

In the Bismuth classification of postoperative biliary strictures, type I is a low common hepatic duct stricture more than 2 cm below the hilum, type II lies less than 2 cm below the confluence, type III reaches the confluence with the ducts still in continuity, and type IV destroys the confluence so the ducts are separated. D stricture over 2 cm below the confluence is therefore type I.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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