title: Long-term health-related quality of life after iatrogenic bile duct injury repair.
abstract: BACKGROUND
  Data on the effect of bile duct injuries (BDI) on health-related quality of life (HRQOL) are not well defined. We sought to assess long-term HRQOL after BDI repair in a large cohort of patients spanning a 23-year period.
  
  
  METHODS
  We identified and mailed HRQOL questionnaires to all patients treated for major BDI after laparoscopic cholecystectomy between January 1, 1990 and December 31, 2012 at Johns Hopkins Hospital.
  
  
  RESULTS
  We identified 167 patients alive at the time of the study who met the inclusion criteria. Median age at BDI was 42 years (interquartile range 31 to 54 years); the majority of patients were female (n = 131 [78.4%]) and of white race (n = 137 [83.0%]). Most patients had Bismuth level 2 (n = 56 [33.7%]) or Bismuth level 3 (n = 40 [24.1%]) BDI. Surgical repair most commonly involved a Roux-en-Y hepaticojejunostomy (n = 142 [86.1%]). Sixty-two patients (37.1%) responded to the HRQOL questionnaire. Median follow-up was 169 months (interquartile range 125 to 222 months). At the time of BDI, mental health was most affected, with patients commonly reporting a depressed mood (49.2%) or low energy level (40.0%). These symptoms improved significantly after definitive repair (both p < 0.05). Limitations in physical activity and general health remained unchanged before and after surgical repair (both p > 0.05).
  
  
  CONCLUSIONS
  Mental health concerns were more commonplace vs physical or general health issues among patients with BDI followed long term. Optimal multidisciplinary management of BDI can help restore HRQOL to preinjury levels.
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Department of Surgery, University of Illinois Hospital and Health Sciences Center, Chicago, IL.
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dodson
authors.affiliation: Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome