ATOM, the all-inclusive, nominal EAES classification of bile duct injuries during cholecystectomy
Por:
Fingerhut, A, Dziri, C, Garden, OJ, Gouma, D, Millat, B, Neugebauer, E, Paganini, A, Targarona, E
Publicada:
1 dic 2013
Resumen:
Several studies seem to indicate at least a 2-fold increase in bile duct injuries (BDI) since the inception of laparoscopic cholecystectomy. Moreover, injuries seem to be more proximal, seem to be revealed earlier, are expressed by leaks more often than by strictures, are repaired more frequently by nonspecialists (either during the index operation or soon after), and appear to be more often associated with loss of substance and ischemia. The plethora of prior classifications probably attests to the evolving clinical spectrum, the mounting wealth of ever-increasing diagnostic methods, and an acknowledgment of insufficiencies or lack of data in earlier classification reports. Previous attempts at uniformity remain incomplete. The purpose of this study was to devise a nominal classification, combining all existing classification items, taking into account the changing pattern of BDI.
Extensive bibliographic research, analysis of each category within the individual classifications combined into one uniform classification.
Fifteen classifications were retained. All items were integrated into the European Association for Endoscopic Surgery (EAES) classification, using semantic connotations, grouped in three easy-to-remember categories, A (for anatomy), To (for time of), M (for mechanism): (1) the anatomic characteristics of the injury: NMBD for non-main bile duct or MBD for main bile duct (followed by a number 1-6, corresponding to the anatomic level on the MBD), followed by Oc (for occlusion) or D (division), P (partial) or C (complete), LS (loss of substance), VBI (vasculobiliary injury in general), and whenever known, the vessel; (2) time of detection: Ei (early intraoperative), Ep (early postoperative) or L (late); and (3) mechanism of injury: Me (mechanical) or ED (energy-driven).
The EAES composite, all-inclusive, nominal classification ATOM (anatomic, time of detection, mechanism) should allow combination of all information on BDI, irrespective of the original classification used, and thus facilitate epidemiologic and comparative studies; indicate simple, appropriate preventive measures; and better guide therapeutic indications for iatrogenic BDI occurring during cholecystectomy.
Filiaciones:
Fingerhut, A:
Univ Athens, Sch Med, Hippokrat Hosp, Dept Surg 1, GR-11527 Athens, Greece
Med Univ Graz, Dept Surg, Sect Surg Res, Graz, Austria
Dziri, C:
Charles Nicolle Univ Hosp, Dept Surg B, Tunis, Tunisia
Garden, OJ:
Univ Edinburgh, Surg Clin, Royal Infirm, Edinburgh EH3 9YW, Midlothian, Scotland
Gouma, D:
Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands
Millat, B:
Univ Montpellier, Hop St Eloi, Dept Surg, F-34059 Montpellier, France
Neugebauer, E:
Private Univ Witten Herdecke, Lehrstuhl Chirurg Forsch, IFOM FOM Inst Forsch Operat Med, D-51109 Cologne, Germany
Paganini, A:
Dipartemento Rome, Div Clin Chirurg 2, Rome, Italy
Targarona, E:
St Pau Univ Hosp, Dept Surg, Barcelona, Spain
Open Access
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