**6. Classification of iatrogenic bile duct injuries**

Different IBDI classifications are described in the literature. In our opinion, the Bismuth classification is the most useful in a clinical practice (described in figure 1). It is based on location of the injury in the biliary tract. This classification is very helpful in prognosis after repair, but does not involve the wide spectrum of possible biliary injuries. The another classification is the Strasberg scale which, in difference from the Bismuth scale, allows to distinguish small (bile leakage from the cystic duct) and serious injuries performed during laparoscopic cholecystectomy, but it does not play an important role in choice of surgical treatment method. The Mattox classification of IBDI takes into consideration a kind of injuring factor (contusion, laceration, perforation, transsection, distraction or interruption of the bile duct or the gallbladder). There are several classifications of IBDI performed during laparoscopic cholecystectomy (Steward and Way, Schmidt, Hannover) in the literature.

I. Common bile duct (CBD) and low common hepatic duct (CHD) > 2cm. from hepatic duct confluence. II. Proximal CHD < 2cm from confluence. III. Hilar injury with no residual CHD – confluence intact. IV. Destruction of confluence – right and left hepatic ducts separated. V. Involvement of aberrant right sectoral hepatic duct alone or with concomitant injury of CHD.

Fig. 1. Bismuth classification of IBDI.
