Suspected Bile Duct Injury
Post-cholecystectomy bilious drainage, jaundice, sepsis
All Pathways
Hepatobiliary SurgeryDiagnostic
Bile Duct Injury Classification & Management - Strasberg
Bile Duct Injury Classification & Management - Strasberg: Suspected Bile Duct Injury → Diagnostic Workup → Strasberg Classification → Type A: Cystic Duc...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Diagnostic Workup
Labs, imaging, cholangiography
- LFTs, WBC, bili trend
- CT abdomen for collections
- MRCP or ERCP for anatomy
03Decision Strasberg Classification
- A: Cystic duct leak or minor duct injury
- B: Occlusion of aberrant right hepatic duct
- C: Transection of aberrant duct without occlusion
- D: Lateral CBD injury (<50%)
- E1-E5: CBD transection at various levels
04Action Type A: Cystic Duct Leak
Minor injury, usually ERCP manageable
05Action ERCP + Stent/Sphincterotomy
First-line for Type A
- Biliary sphincterotomy
- Temporary biliary stent
- Percutaneous drain if collection
06End Long-term Surveillance
LFTs, imaging for stricture, quality of life assessment
07Action Type B-D: Partial/Aberrant Duct
Variable management
08Action Conservative/Endoscopic
Depends on specific injury
- Type B: may atrophy, observe
- Type C: ERCP if accessible
- Type D: ERCP stent if <50%
- Path rejoins step 06Shared downstream outcome
09Action HPB Center Referral
Essential for major injuries
- Control sepsis first
- Establish biliary drainage (PTC/ERCP)
- Delay definitive repair 6-12 weeks if inflamed
10Action Surgical Repair
Hepaticojejunostomy (Roux-en-Y)
- After inflammation resolves
- High (proximal) repair if possible
- Meticulous technique, experienced surgeon
- Path rejoins step 06Shared downstream outcome
11Action Type E: Major CBD Injury
Requires surgical repair
12Decision Associated Vascular Injury?
- Right hepatic artery injury
- Portal vein injury
- Affects repair planning
- Path rejoins step 09Shared downstream outcome
Guideline Source
SAGES Safe Cholecystectomy Task Force and Bile Duct Injury Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Early recognition crucial - delayed repair has worse outcomes
- Transfer to HPB center for major injuries
- Associated vascular injury worsens prognosis
- Long-term stricture surveillance needed
Applicable Regions
USAUUKEU
EU: EAES bile duct injury guidelines
US: SAGES safe cholecystectomy guidelines
Version 1Next review: 2028-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Bile Duct Injury Classification & Management - Strasberg?
The Bile Duct Injury Classification & Management - Strasberg is a diagnostic clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on SAGES Safe Cholecystectomy Task Force and Bile Duct Injury Guidelines.
What guideline is the Bile Duct Injury Classification & Management - Strasberg based on?
This algorithm is based on SAGES Safe Cholecystectomy Task Force and Bile Duct Injury Guidelines (DOI: 10.1007/s00464-020-07498-6).
What are the limitations of the Bile Duct Injury Classification & Management - Strasberg?
Known limitations include: Early recognition crucial - delayed repair has worse outcomes; Transfer to HPB center for major injuries; Associated vascular injury worsens prognosis; Long-term stricture surveillance needed. Individual patient factors may require deviation from these recommendations.
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