Strasberg classification of bile duct injury

Last revised by Dr Henry Knipe on 02 Jun 2020

The Strasberg classification of bile duct injury is a widely used system to anatomically define these injuries by location 1. 

Classification

  • type A: injury to the cystic duct or from minor hepatic ducts draining the liver bed
  • type B: occlusion of the biliary tree, commonly aberrant right hepatic duct(s)
  • type C: transection without ligation of aberrant right hepatic duct(s)
  • type D: lateral injury to a major bile duct
  • type E: injury to the main hepatic duct; classified according to the level of injury
    • E1 (Bismuth type 1): injury more than 2 cm from the confluence
    • E2 (Bismuth type 2): injury less than 2 cm from the confluence
    • E3 (Bismuth type 3): injury at the confluence; confluence intact
    • E4 (Bismuth type 4): destruction of the biliary confluence
    • E5 (Bismuth type 5): injury to the aberrant right hepatic duct 

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