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ATOM Classification of Bile Duct Injuries During Laparoscopic Cholecystectomy: Analysis of a Single Institution Experience.

A new interesting article has been published in J Laparoendosc Adv Surg Tech A. 2018 Sep 25. doi: 10.1089/lap.2018.0413. and titled:

ATOM Classification of Bile Duct Injuries During Laparoscopic Cholecystectomy: Analysis of a Single Institution Experience.

Authors of this article are:
Balla A Quaresima S Corona M Lucatelli P Fiocca F Rossi M Bezzi M Catalano C Salvatori FM Fingerhut A Paganini AM.

A summary of the article is shown below:
PURPOSE: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC.METHODS: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis.RESULTS: Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover).CONCLUSIONS: The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.

Check out the article’s website on Pubmed for more information:



This article is a good source of information and a good way to become familiar with topics such as: ATOM classification;EAES classification;bile duct injuries (BDI);endoscopic retrograde cholangiopancreatography (ERCP);laparoscopic cholecystectomy;percutaneous transhepatic cholangiography (PTC).

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