Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 7. Quality of life after bile duct injury during laparoscopic cholecystectomy.

Objective: To assess the impact of bile duct injury (BDI) sustained during laparoscopic cholecystectomy on physical and mental quality of life (QOL). Methods: One-hundred and six consecutive patients (75 women, median age 44 yr [standard deviation 14 yr]) were referred between 1990 and 1996 for treatment of BDI sustained during laparoscopic cholecystectomy. Outcome was evaluated according to the type of treatment (endoscopic or surgical) and the type of injury. Objective outcomes (interventions, hospital admissions and laboratory data) were evaluated, a questionnaire was filled out and a QOL survey was performed (Medical Outcomes Study Short Form Health Survey [SF-36]). Risk factors predicting a worse outcome were assessed. QOL results were compared to those of a healthy control group and another group who had undergone uncomplicated laparoscopic cholecystectomy more than 2 years previously. Results: There were 36 type A injuries (leaks of the cystic duct or duct of Lushka), 24 type B injuries (major or minor BDI, 15 type C and 31 type D injuries (major BDIs). Median follow-up time was 70 (range from 37–110) months. Following endoscopic treatment (n = 69), outcome was excellent in 94% and following surgical treatment outcome was excellent in 84% but depended on the timing of treatment. Five patients underwent interventional radiology with a good outcome. Eighty-two completed the QOL assessment. Despite the excellent objective outcome, QOL was significantly reduced compared with controls in all subscales and was not dependent on the type of treatment or the severity of the injury. The duration of the treatment was an independent prognostic factor for a worse mental QOL. Conclusion: Despite the excellent functional outcome after treatment of BDI during laparoscopic cholecystectomy, the occurrence of a BDI has a negative impact on the patient's QOL even at long-term follow-up.