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Quality-of-Life Assessment of Surgical Reconstruction After Laparoscopic Cholecystectomy–Induced Bile Duct Injuries
What Happens at 5 Years and Beyond?
Juan M. Sarmiento, MD;
Michael B. Farnell, MD;
David M. Nagorney, MD;
David O. Hodge, MS;
Jeffrey R. Harrington, BS
Arch Surg. 2004;139:483-489.
Hypothesis Quality of life of patients after biliary reconstruction for laparoscopic injuries is comparable to that of patients after laparoscopic cholecystectomy.
Design Outcomes study.
Setting Tertiary referral center.
Patients Records of 59 consecutive patients undergoing surgical reconstruction of the biliary tract after injury induced by laparoscopic cholecystectomy between 1990 and 1997 were reviewed. Hepp-Couinaud technique or Roux-en-Y hepaticojejunostomy was used in 53 patients; other procedures included cholangiojejunostomy, choledochorrhaphy, and hepaticoduodenostomy.
Interventions Quality-of-life questionnaires (36-Item Short-Form Health Survey [SF-36]) were mailed to each patient in the group and to patients who underwent uneventful laparoscopic cholecystectomy, matched individually by year, sex, and age group. Values from the general population matched by age and sex were gathered (national norms). Minimum time of follow-up was 5 years.
Results Eighty-nine (81%) of 110 potential respondents to the survey completed the SF-36 questionnaires. All 8 values evaluated in the SF-36 questionnaire (physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health index) for patients undergoing biliary reconstruction were similar to those of both their matched controls (all P >.10) and national norms (all P >.05). The standardized physical component scale was also similar between the 2 groups (cases vs controls, 51 vs 48; P = .47), as was the standardized mental component scale (cases vs controls, 55 vs 55; P = .60).
Conclusions With a minimum of 5 years of follow-up, the quality of life after surgical biliary reconstruction compares favorably with that of both patients undergoing uneventful laparoscopic cholecystectomy and national norms.
From the Divisions of Gastroenterologic and General Surgery (Drs Sarmiento, Farnell, and Nagorney) and Biostatistics (Messrs Hodge and Harrington), Mayo Clinic and Mayo Foundation, Rochester, Minn. Dr Sarmiento is now with the Division of Gastroenterologic and General Surgery, Emory University, Atlanta, Ga.
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