Clinical Application of the Hanover Classification for Iatrogenic Bile Duct Lesions
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 Classification
Type of injury
n (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
A1
7
4x drainage alone or direct suture of leak with or without t-tube placement 3x hepaticojejunostomy at the level of the common hepatic duct
A2
5
1x 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
B1
1
1 x resection of the bifurcation of the common bile duct and hepaticojejunostomy
B2
3
2x 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
C1
1
1x hepaticojejunostomy at the level of the common hepatic duct
C2
5
3x hepaticojejunostomy at the level of the common hepatic duct 2x Whipple’s procedure
C2d
1
1 x hepaticojejunostomy at the level of the common hepatic duct
C3
2
1x resection of the bifurcation of the common bile duct and hepaticojejunostomy 1x hepaticojejunostomy at the level of the common hepatic duct
C4
3
1x 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
D1
7
2x 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
D2
19
1x resection of the bifurcation of the common bile duct and hepaticojejunostomy 18x hepaticojejunostomy at the level of the common hepatic duct
D2d
6
2x 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
D3
7
2x 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
D3d
2
1x 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 + pv
1
1x right anatomical liver resection and resection of the bifurcation of the common bile duct and hepaticojejunostomy
D3pv
1
1x resection of the bifurcation of the common bile duct and hepaticojejunostomy
D4
9
2x hepaticojejunostomy at the level of the common hepatic duct 7x resection of the bifurcation of the common bile duct and hepaticojejunostomy
D4c
1
1x hepatic segmentectomy
D4d
6
4x 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 + pv
2
2x 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
E1
0
E2
3
3x hepaticojejunostomy at the level of the common hepatic duct
E3
1
1x resection of the bifurcation of the common bile duct and hepaticojejunostomy
