Table 3: Shown is a summary of specifically proposed initial surgical approaches for different types of bile duct lesions as classified by the Hanover classification versus the actually performed primary or secondary surgical treatment in our study.

Proposed initial treatment according to the Hanover ClassificationType of injuryn (93)Actually performed primary or secondary treatment in our institution

Bile leakage

Drainage alone or direct suture of leak with or without t-tube placement
66 % congruence between theory and practice
A174x drainage alone or direct suture of leak with or without t-tube placement
3x hepaticojejunostomy at the level of the common hepatic duct
A251x hepatic segmentectomy
4x drainage alone or direct suture of leak with or without t-tube placement

Stenosis of the common bile duct

Removal of clips, drainage, and stenting or T-tube drainage of the bile duct. In case of necrosis of the duct wall: resection and primary reconstruction or hepaticojejunostomy.
75 % congruence between theory and practice
B111 x resection of the bifurcation of the common bile duct and hepaticojejunostomy
B232x resection of the bifurcation of the common bile duct and hepaticojejunostomy
1x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy

Tangential injury

Primary reconstruction with drainage and stenting of the bile duct or hepatico-jejunostomy. In case of injury of the right hepatic artery a liver resection is usually necessary
90% congruence between theory and practice
C111x hepaticojejunostomy at the level of the common hepatic duct
C253x hepaticojejunostomy at the level of the common hepatic duct
2x Whipple’s procedure
C2d11 x hepaticojejunostomy at the level of the common hepatic duct
C321x resection of the bifurcation of the common bile duct and hepaticojejunostomy
1x hepaticojejunostomy at the level of the common hepatic duct
C431x resection of the bifurcation of the common bile duct and hepaticojejunostomy
2x hepaticojejunostomy at the level of the common hepatic duct

Complete transection of the common bile duct

Primary end to end reconstruction with stenting and drainage or hepaticojejunostomy. In case of injury of the right hepatic artery, a liver resection is usually necessary
72% congruence between theory and practice
D172x resection of the bifurcation of the common bile duct and hepaticojejunostomy
4x hepaticojejunostomy at the level of the common hepatic duct
1x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
D2191x resection of the bifurcation of the common bile duct and hepaticojejunostomy
18x hepaticojejunostomy at the level of the common hepatic duct
D2d62x hepaticojejunostomy at the level of the common hepatic duct
3x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
1x hepaticojejunostomy at the level of the common hepatic duct with additional arterial reconstruction of the right hepatic artery
D372x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
4x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
1x hepaticojejunostomy at the level of the common hepatic duct
D3d21x hepaticojejunostomy at the level of the common hepatic duct
1x resection of the bifurcation of the common bile duct and hepaticojejunostomy with additional reconstruction of the right hepatic artery and the portal vein.
D3 d + pv11x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
D3pv11x resection of the bifurcation of the common bile duct and hepaticojejunostomy
D492x hepaticojejunostomy at the level of the common hepatic duct
7x resection of the bifurcation of the common bile duct and hepaticojejunostomy
D4c11x hepatic segmentectomy
D4d64x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
2x resection of the bifurcation of the common bile duct and hepaticojejunostomy
D4d + pv22x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy

Strictures of the common bile duct

Stenting or hepaticojejunostomy
100% congruence between theory and practice while initial therapy in primary hospitals
E10
E233x hepaticojejunostomy at the level of the common hepatic duct
E311x resection of the bifurcation of the common bile duct and hepaticojejunostomy
E40