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Derek E. Moore, MD; Irene D. Feurer, PhD; Michael D. Holzman, MD, MPH; Leonard J. Wudel, MD; Carolyn Strickland, BSN; D. Lee Gorden, MD; Ravi Chari, MD; J. Kelly Wright, MD; C. Wright Pinson, MD, MBA

Arch Surg. 2004;139:476-482.

Hypothesis  Long-term quality of life (QOL) in patients undergoing laparoscopic cholecystectomy (LC) incurring bile duct injury (BDI) and repair is comparable to that of patients undergoing uncomplicated LC.

Design  Case comparison study.

Setting  Secondary and tertiary care centers.

Patients  Eighty-six patients incurring BDI during LC between January 1, 1991, and July 31, 2003, were surveyed. Comparison subjects underwent uncomplicated LC during the same period.

Main Outcome Measures  Health-related QOL as assessed by the Karnofsky Performance Scale, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and Psychosocial Adjustment to Illness Scale.

Results  Fifty patients with BDI (39 [78%] female; mean ± SEM age, 55 ± 2 years) and 74 patients with uncomplicated LC (51 [69%] female, mean ± SEM age, 52 ± 2 years) responded. Of the 50 BDI patients, 48 (96%) had no stricture and normal liver function at QOL assessment. The mean ± SEM follow-up period to QOL assessment for the BDI and uncomplicated LC groups was 62 ± 6 and 47 ± 3 months, respectively. The mean ± SD Karnofsky Performance Scale scores were 77 ± 9 vs 93 ± 8 for the 2 groups, respectively (P <.001). The mean ± SD SF-36 physical component scale scores after BDI vs uncomplicated LC were 36 ± 11 vs 47 ± 12, respectively (P <.001), compared with 50 ± 10 for the normal population (P <.001). The mean ± SD SF-36 mental component scale scores were 43 ± 14 vs 49 ± 11 for the 2 groups, respectively (P = .02), compared with 50 ± 10 for the normal population (P = .01). Patients with BDI scored poorer on the Psychosocial Adjustment to Illness Scale health care orientation and domestic environment scales (P=.01).

Conclusion  After BDI and repair, there are long-term detrimental effects of BDI on health-related QOL.

From the Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tenn.

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Arch Surg. 2004;139(5):465.
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