A retrospective analysis of bile duct injuries treated in a tertiary center: the utility of a universal classification-the ATOM classification.
ATOM classification
Bile duct injury
Laparoscopic cholecystectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
12
05
2022
accepted:
16
07
2022
pubmed:
11
8
2022
medline:
18
1
2023
entrez:
10
8
2022
Statut:
ppublish
Résumé
Bile duct injuries (BDI) are the most feared complications that can occur after laparoscopic cholecystectomy (LC). BDI have a high variability and complexity, several classifications being developed along the years in order to correctly assess and divide BDI. The EAES ATOM classification encompasses all the important details of a BDI: A (for anatomy), To (for time of), and M (for mechanism) but have not gained universal acceptance yet. Our study intents to analyze the cases of BDI treated in our institution with a focus on the clinical utility of the ATOM classification. We conducted a retrospective study, on a 10-year period (2011-2020), including patients diagnosed with BDI after LC, with their definitive treatment performed in our tertiary center. All injuries were retrospectively classified using the Strasberg, Hannover, and ATOM classifications. We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively assessing all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury, many types of BDI according to ATOM being included in the same Strasberg or Hannover category. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. An important percentage of cases (31%) underwent a primary treatment in the hospital of origin, reintervention with definitive treatment being done in our department. The ATOM classification is the best suited for accurately describing the complexity of a BDI, serving as a template for discussing the correct management for each lesion. Efforts should be made toward increasing the use of this classification in day-to-day clinical practice.
Sections du résumé
BACKGROUND
Bile duct injuries (BDI) are the most feared complications that can occur after laparoscopic cholecystectomy (LC). BDI have a high variability and complexity, several classifications being developed along the years in order to correctly assess and divide BDI. The EAES ATOM classification encompasses all the important details of a BDI: A (for anatomy), To (for time of), and M (for mechanism) but have not gained universal acceptance yet. Our study intents to analyze the cases of BDI treated in our institution with a focus on the clinical utility of the ATOM classification.
METHODS
We conducted a retrospective study, on a 10-year period (2011-2020), including patients diagnosed with BDI after LC, with their definitive treatment performed in our tertiary center. All injuries were retrospectively classified using the Strasberg, Hannover, and ATOM classifications.
RESULTS
We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively assessing all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury, many types of BDI according to ATOM being included in the same Strasberg or Hannover category. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. An important percentage of cases (31%) underwent a primary treatment in the hospital of origin, reintervention with definitive treatment being done in our department.
CONCLUSION
The ATOM classification is the best suited for accurately describing the complexity of a BDI, serving as a template for discussing the correct management for each lesion. Efforts should be made toward increasing the use of this classification in day-to-day clinical practice.
Identifiants
pubmed: 35948807
doi: 10.1007/s00464-022-09497-z
pii: 10.1007/s00464-022-09497-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
347-357Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Litwin DEM, Cahan MA (2008) Laparoscopic cholecystectomy. Surg Clin North Am 88:1295–1313. https://doi.org/10.1016/j.suc.2008.07.005
doi: 10.1016/j.suc.2008.07.005
Saad N, Darcy M (2008) Iatrogenic bile duct injury during laparoscopic cholecystectomy. Tech Vasc Interv Radiol 11:102–110. https://doi.org/10.1053/j.tvir.2008.07.004
doi: 10.1053/j.tvir.2008.07.004
Babel N, Sakpal SV, Paragi P, Wellen J, Feldman S, Chamberlain RS (2009) Iatrogenic bile duct injury associated with anomalies of the right hepatic sectoral ducts: a misunderstood and underappreciated problem. HPB Surg 2009:1–4. https://doi.org/10.1155/2009/153269
doi: 10.1155/2009/153269
Pesce A, Palmucci S, la Greca G, Puleo S (2019) Iatrogenic bile duct injury: impact and management challenges. Clin Exp Gastroenterol 12:121–128. https://doi.org/10.2147/CEG.S169492
doi: 10.2147/CEG.S169492
Chuang KI, Corley D, Postlethwaite DA, Merchant M, Harris HW (2012) Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries? Am J Surg 203:480–487. https://doi.org/10.1016/j.amjsurg.2011.08.018
doi: 10.1016/j.amjsurg.2011.08.018
Lau WY, Lai ECH, Lau SHY (2010) Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg 80:75–81. https://doi.org/10.1111/j.1445-2197.2009.05205.x
doi: 10.1111/j.1445-2197.2009.05205.x
Schreuder AM, Busch OR, Besselink MG, Ignatavicius P, Gulbinas A, Barauskas G, Gouma DJ, van Gulik TM (2020) Long-term impact of iatrogenic bile duct injury. Dig Surg 37:10–21. https://doi.org/10.1159/000496432
doi: 10.1159/000496432
Cohen JT, Charpentier KP, Beard RE (2019) An update on iatrogenic biliary injuries. Surg Clin North Am 99:283–299. https://doi.org/10.1016/j.suc.2018.11.006
doi: 10.1016/j.suc.2018.11.006
de Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, de Simone B, di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard M-A, Allievi N, Sommacale D (2021) 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 16:30. https://doi.org/10.1186/s13017-021-00369-w
doi: 10.1186/s13017-021-00369-w
van de Graaf FW, Zaïmi I, Stassen LPS, Lange JF (2018) Safe laparoscopic cholecystectomy: a systematic review of bile duct injury prevention. Int J Surg 60:164–172. https://doi.org/10.1016/j.ijsu.2018.11.006
doi: 10.1016/j.ijsu.2018.11.006
Lau W-Y, Lai ECH (2007) Classification of iatrogenic bile duct injury. Hepato. Pancreat Dis Int 6:459–463
Chun K (2014) Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg 18:69. https://doi.org/10.14701/kjhbps.2014.18.3.69
doi: 10.14701/kjhbps.2014.18.3.69
Fingerhut A, Dziri C, Garden OJ, Gouma D, Millat B, Neugebauer E, Paganini A, Targarona E (2013) ATOM, the all-inclusive, nominal EAES classification of bile duct injuries during cholecystectomy. Surg Endosc 27:4608–4619. https://doi.org/10.1007/s00464-013-3081-6
doi: 10.1007/s00464-013-3081-6
Šileikis A, Žulpaitė R, Šileikytė A, Lukšta M (2019) Postcholecystectomy bile duct injuries: evolution of surgical treatment. Pol J Surg 91:14–21. https://doi.org/10.5604/01.3001.0012.7810
doi: 10.5604/01.3001.0012.7810
Balla A, Quaresima S, Corona M, Lucatelli P, Fiocca F, Rossi M, Bezzi M, Catalano C, Salvatori FM, Fingerhut A, Paganini AM (2019) ATOM classification of bile duct injuries during laparoscopic cholecystectomy: analysis of a single institution experience. J Laparoendosc Adv Surg Tech 29:206–212. https://doi.org/10.1089/lap.2018.0413
doi: 10.1089/lap.2018.0413
Cuschieri A, Terblanche J (1990) Laparoscopic cholecystectomy: evolution, not revolution. Surg Endosc 4:125–126. https://doi.org/10.1007/BF02336585
doi: 10.1007/BF02336585
Gaillard M (2015) New minimally invasive approaches for cholecystectomy: review of literature. World J Gastrointest Surg 7:243. https://doi.org/10.4240/wjgs.v7.i10.243
doi: 10.4240/wjgs.v7.i10.243
Alexander HC, Bartlett AS, Wells CI, Hannam JA, Moore MR, Poole GH, Merry AF (2018) Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB 20:786–794. https://doi.org/10.1016/j.hpb.2018.03.004
doi: 10.1016/j.hpb.2018.03.004
Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, Schwartz JS, Williams SV (1996) Mortality and complications associated with laparoscopic cholecystectomy. Ann Surg 224:609–620. https://doi.org/10.1097/00000658-199611000-00005
doi: 10.1097/00000658-199611000-00005
Strasberg SM (2019) A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci 26:123–127. https://doi.org/10.1002/jhbp.616
doi: 10.1002/jhbp.616
Renz BW, Bösch F, Angele MK (2017) Bile duct injury after cholecystectomy: surgical therapy. Visceral Med 33:184–190. https://doi.org/10.1159/000471818
doi: 10.1159/000471818
Söderlund C, Frozanpor F, Linder S (2005) Bile duct injuries at laparoscopic cholecystectomy: a single-institution prospective study. Acute cholecystitis indicates an increased risk. World J Surg 29:987–993. https://doi.org/10.1007/s00268-005-7871-4
doi: 10.1007/s00268-005-7871-4
Törnqvist B, Waage A, Zheng Z, Ye W, Nilsson M (2016) Severity of acute cholecystitis and risk of iatrogenic bile duct injury during cholecystectomy, a population-based case-control study. World J Surg 40:1060–1067. https://doi.org/10.1007/s00268-015-3365-1
doi: 10.1007/s00268-015-3365-1
Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, Endo I, Umezawa A, Asai K, Suzuki K, Mori Y, Okamoto K, Pitt HA, Han H-S, Hwang T-L, Yoon Y-S, Yoon D-S, Choi I-S, Yamamoto M (2018) Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:73–86. https://doi.org/10.1002/jhbp.517
doi: 10.1002/jhbp.517
Eikermann M, Siegel R, Broeders I, Dziri C, Fingerhut A, Gutt C, Jaschinski T, Nassar A, Paganini AM, Pieper D, Targarona E, Schrewe M, Shamiyeh A, Strik M, Neugebauer EAM (2012) Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc 26:3003–3039. https://doi.org/10.1007/s00464-012-2511-1
doi: 10.1007/s00464-012-2511-1