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Validation of the Lucknow BCD Classification for Acute Bile Duct Injury
Vinay K. Kapoor*, Joy Abraham, Anu Behari, Anand Prakash, Rajneesh K. Singh, Ashok Kumar, Rajan Saxena
Surgical Gastroenterology, SGPGIMS, Lucknow, UP, India
Introduction
There are as many as 15 classifications for acute bile duct injury (BDI). We had earlier proposed a BCD (bile leak, circumference involved and duct injured) classification of acute BDI. We now present validation of our BCD classification with our experience of management and outcome of 162 patients with acute BDI.
Methods
Between 2001 and 2010, 202 patients with acute BDI were managed. Complete information for classification of injury and long term outcome was available in 162 patients which were analyzed by classifying the BDI according to our BCD classification and outcome.
Results
The commonest prototype was by ByCf Ds (bile leak yes, full circumference, significant duct) (n=94). In this group, external biliary fistula (EBF) was less likely to close and biliary stricture formation was likely. EBF closed in only 29 (31%) and biliary stricture formed in 87 (93%) of 94 patients. In the second prototype ByCpDs (bile leak yes, partial circumference, significant duct) (n=37), the EBF was more likely to close and biliary stricture formation was less likely. EBF closed in 25 (68%) and biliary stricture formed in 18 (49%) of 37 patients. In the third prototype ByCnaDi (bile leak yes, circumference no applicable, insignificant duct) (n=29), the EBF was likely to close spontaneously and biliary stricture was not predicted to form in any patient. EBF closed in 26 (90%) and biliary stricture formed in only 2 (7%) of 29 patients.
Conclusion
Our simple and easy to remember BCD classification was validated with our experience of 162 patients. The BDI prototype correctly predicted the outcome in terms of closure of EBF and formation of biliary stricture. We propose to name it the Lucknow BCD Classification of acute BDI.
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