Biliary strictures: Classification based on the principles of surgical treatment

The classification of biliary strictures used at Hopital Paul Brousse is ba sed on the lowest level at which healthy biliary mucosa is available for an astomosis. The classification is intended to help the surgeon choose the ap propriate technique for the repair. Type I strictures, with a common duct s tump longer than 2 cm, can be repaired without opening the left duct and wi thout lowering the hilar plate. Type II strictures, with a stump shorter th an 2 cm, require opening the left duct for a satisfactory anastomosis. Lowe ring the hilar plate is not always necessary but may improve the exposure. Type III lesions, in which only the ceiling of the biliary confluence is in tact, require lowering the hilar plate and anastomosis on the left ductal s ystem. There is no need to open the right duct if the communication between the ducts is wide. With type IV lesions the biliary confluence is interrup ted and requires either reconstruction or two or more anastomoses. Type V l esions are strictures of the hepatic duct associated with a stricture on a separate right branch, and the branch must be included in the repair. Altho ugh this classification is intended for established strictures, it is commo nly used to describe acute bile duct injuries. The surgeon must be aware, h owever, that the established stricture is generally one level higher than t he level of the injury at the original operation.