Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy - A prospective analysis

Objective To assess the impact of bile duct injury (BDI) sustained during l aparoscopic cholecystectomy on physical and mental quality of life (QOL). Summary Background Data The incidence of BDI during laparoscopic cholecyste ctomy has decreased but remains as high as 1.4%. Data on the long-term outc ome of treatment in these patients are scarce, and QOL after BDI is unknown . Methods One hundred six consecutive patients (75 women, median age 44 +/- 1 4 years) were referred between 1990 and 1996 for treatment of BDI sustained during laparoscopic cholecystectomy. Outcome was evaluated according to th e type of treatment used (endoscopic or surgical) and the type of injury. O bjective outcome (interventions, hospital admissions, laboratory data) was evaluated, a questionnaire was filled out, and a QOL survey was performed ( using the SF-36). Risk factors for a worse outcome were calculated. Results Median follow-up time was 70 months (range 37-110). The objective o utcome of endoscopic treatment (n = 69) was excellent (94%). The result of surgical treatment (n = 31) depended on the timing of reconstruction (overa ll success 84%; in case of delayed hepaticojejunostomy 94%). Five patients underwent interventional radiology with a good outcome. Despite this excell ent objective outcome, QOL appeared to be both physically and mentally redu ced compared with controls (P < .05) and was not dependent on the type of t reatment used or the severity of the injury. The duration of the treatment was independently prognostic for a worse mental QOL. Conclusions Despite the excellent functional outcome after repair, the occu rrence of a BDI has a great impact on the patient's physical and mental QOL , even at long-term follow-up.