Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment.
OBJECTIVE
Bile duct injury (BDI) is associated with increased morbidity and poor survival. The aim of the present study was to compare quality of life (QoL) between patients with BDI and those without after laparoscopic cholecystectomy. A longitudinal assessment was performed and risk factors for poor QoL were determined.


METHODS
In March 2005 a survey was performed of 403 eligible patients with BDI who were referred to a tertiary center for multidisciplinary treatment by gastroenterologists, radiologists, and surgeons. A longitudinal quality-of-life study was performed to determine changes in outcome after a mean of 5.5 and 11 years' follow-up.


RESULTS
Of the eligible 403 patients with BDI, 278 (69 %) responded to the survey after a mean follow-up of 5.9 years. The quality-of-life outcome of injured patients was significantly lower in three of the eight domains compared to patients who underwent cholecystectomy without an injury ( P < 0.05). In seven of the eight QoL domains injured patients scored significantly worse than the healthy population norms ( P < 0.05). The longitudinal assessment after another 5.5 years of follow-up did not show improvement in QoL. Clinical characteristics such as the type of injury and the type of treatment did not affect outcome. Nineteen percent of the patients (n = 53) filed a malpractice claim after BDI. These patients reported better QoL (effect size = 0.6, P = 0.02) when the claim was resolved in their favor than when the claim was rejected.


CONCLUSIONS
BDI has a detrimental effect on long-term QoL. QoL in patients with BDI is poor and does not improve during follow-up. The outcome of a malpractice litigation claim is associated with QoL.
de Reuver
P R
PR
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Sprangers
M A
MA
Rauws
E A
EA
Lameris
J S
JS
Busch
O R
OR
van Gulik
T M
TM
Gouma
D J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries*; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires