EAES classification matrix for bile duct injuries
For each injury, the surgeon fills in the following matrix
1) Date of injury date____/mo____/year____
2) Date of diagnosis date____/mo____/year____
3) single injury (yes/no)
4) multiple injuries (yes/no), fill in one matrix for each injury, as appropriate
5) injury occurred
a. during laparotomy
b. during laparoscopy
6) total number of cholecystectomies performed by the same unit
a. number by laparotomy
b. number by laparoscopy
c. number of conversions
Anatomical characteristics
Type and extent of injury
Anatomic
level
Occlusion (O)
Complete
(C)
Partial
(P)*
Division (D)
Complete
(C)
Partial
(P)*
Loss of Substance
(LS)**
Vasculobiliary injury
(yes=VBI+) and name of
injured vessel
(RHA, LHA, CHA,
PV, MV);
(no = VBI-)
Time of detection
Indicate Ei, Ep or L
E: Early intraoperative
(de visu, bile leak, IOC)
Ep: Early postoperative
(=<7 days)
L: Late (> 7 days)
Mechanism
Indicate: Me or
ED
Me: mechanical
ED: energy-driven
MBD
1
2
3
4
5
6
NMBD
MBD: main biliary duct; NMBD: non main biliary duct (Luschka or other accessory duct); level 1: ≥ 2 cm from lower border of superior biliary confluent; level 2:
< 2 cm from lower border of superior biliary confluent; level 3: involves the superior biliary confluent but communication right left is preserved; 4: involves
superior biliary confluent but communication right left is interrupted; 5: right or left hepatic duct or 6 right sectorial (aberrant) duct in continuity; C: Complete; P:
partial; * (indicate % of circumference if known), LS Loss of substance; ** indicate length if known); Me: mechanical; ED energy driven; VBI: vasculobiliary
involvement; RHA: right hepatic artery; LHA: left hepatic artery; ,CHA: common hepatic artery; PV: portal vein; MA: marginal vessels; Ei: Early intraoperative;
Ep Early postoperative (7 days or less); L: late (8 days or more), OC: intraoperative cholangiograms
For example, a complete division made by an energy-driven (ultrasonic) dissector involving the superior biliary confluence with interruption of communication
between the right and left hepatic ducts, without associated vascular injury, detected (intraoperatively) during the operation by the presence of bile would be
classed: MBD 4 O C VBI Ei, ED
The Connor Garden E6 injury is in fact a type 4 with LS: MBD 4 LS.
EAES classification matrix to indicate the moment of occurrence of BDI
(check when appropriate (“yes”)
Before identification of cystic triangle elements
During identification (dissection) of cystic triangle elements
After identification of cystic triangle elements
Before dissection of gallbladder
During dissection of gallbladder
After dissection of gallbladder (liver bed)
Before critical view of safety attempted
During critical view of safety
After critical view of safety performed
Before intraoperative cholangiogram (IOC) attempted
During IOC (opening the cystic duct or what is thought to be so),
introduction of catheter or instrument for IOC)
After performance of IOC (withdrawal of catheter or instrument)
Before Rouvière’s sulcus seen
After Rouvière’s sulcus seen
During dissection or maneuvers for stone extraction from main bile
duct via cystic duct
During dissection or maneuvers for stone extraction from main bile
duct via common bile
During other maneuvers (hepaticoenterostomy)
During mechanical or energy-driven injury for elective hemostasis or
ligation
During mechanical or energy-driven injury for unexpected bleeding
Before conversion
After conversion