Hepatobiliary Surgery — Flashcards

Flashcard 41: According to Strasberg classification of bile duct injury, injury to main hepatic duct, more than 2cm from confluence is classified as Type _____

Answer: E1

Flashcard 42: Classification of Choledochal Cysts:A cystic dilation of the intramural common bile duct, within the wall of the duodenum, is classified as _____

Answer: Type III

Flashcard 43: _____ classification of bile duct injury takes into account both vascular as well as the location of the injury.

Answer: Hannover

Flashcard 44: Biliary stricture/injury after open cholecystectomy usually occurs in the _____

Answer: common bile duct

Flashcard 45: According to Strasberg classification of bile duct injury, occlusion of biliary tree with no leak is classified as Type _____

Answer: B

Flashcard 46: What is the first step in a post-op detected bile duct injury following laparoscopic cholecystectomy?_____

Answer: Drainage of fluid collections (Pigtail insertion and drainage)

Flashcard 47: What is the treatment of bilhemia?_____

Answer: stent placement or sphincterotomy

Flashcard 48: What is the next step in the management of a post-operative bile leak (CBD/common hepatic duct injury) if the leak persists 1-2 days after USG-guided drainage?

Answer: ERCP (Endoscopic Retrograde Cholangiopancreatography)

Extra: Standard management of post-cholecystectomy bile leaks: 1. **Percutaneous drainage** of collections (USG/CT guided). 2. If the leak persists, **ERCP** is the next step to define the anatomy and provide internal drainage (via stenting or sphincterotomy). 3. Major ductal injuries (e.g., Strasberg E) may ultimately require **Roux-en-Y Hepaticojejunostomy**, which is usually delayed by 6-12 weeks to allow inflammation to subside. *Note: Primary repair over a T-tube is typically an intra-operative management strategy for small lateral injuries, not the standard next step for a persistent post-operative leak.*

Flashcard 49: Post-sx follow up is important in distinguishing biliary type SOD from _____ syndrome

Answer: post-cholecystectomy

Flashcard 50: According to Strasberg classification of bile duct injury, injury to main hepatic duct, at the confluence, with confluence intact is classified as Type _____

Answer: E3