Download PDF
Endoscopy 2008; 40(8): 637-643
DOI: 10.1055/s-2008-1077444
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment

P.  R.  de Reuver1 , M.  A.  G.  Sprangers2 , E.  A.  J.  Rauws3 , J.  S.  Lameris4 , O.  R.  Busch1 , T.  M.  van Gulik1 , D.  J.  Gouma1
  • 1Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  • 2Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
  • 3Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  • 4Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
Further Information

Publication History

submitted 15 November 2007

accepted after revision 28 April 2008

Publication Date:
04 August 2008 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de P. R. de Reuver et al., pp. 637Endoscopy 2008; 40(08): 796-797
DOI: 10.1055/s-0032-1306858

Background and study aims: 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.

Patients and 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.

References

  • 1 Flum D R, Cheadle A, Prela C. et al . Bile duct injury during cholecystectomy and survival in Medicare beneficiaries.  JAMA. 2003;  290 2168-2173
    CrossrefPubMedGoogle Scholar
  • 2 Calvete J, Sabater L, Camps B. et al . Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve?.  Surg Endosc. 2000;  14 608-611
    CrossrefPubMedGoogle Scholar
  • 3 Fletcher D R, Hobbs M S, Tan P. et al . Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.  Ann Surg. 1999;  229 449-457
    CrossrefPubMedGoogle Scholar
  • 4 MacFadyen Jr B V, Vecchio R, Ricardo A E, Mathis C R. Bile duct injury after laparoscopic cholecystectomy. The United States experience.  Surg Endosc. 1998;  12 315-321
    CrossrefPubMedGoogle Scholar
  • 5 Misra S P, Dwivedi M. Endoscopic management of persistent biliary leakage resulting from complete transection of the bile duct at cholecystectomy.  Endoscopy. 2006;  38 598-603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Moossa A R, Easter D W. et al . Laparoscopic injuries to the bile duct. A cause for concern.  Ann Surg. 1992;  215 203-208
    CrossrefPubMedGoogle Scholar
  • 7 Costamagna G, Pandolfi M, Mutignani M. et al . Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents.  Gastrointest Endosc. 2001;  54 162-168
    CrossrefPubMedGoogle Scholar
  • 8 Savader S J, Lillemoe K D, Prescott C A. et al . Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster.  Ann Surg. 1997;  225 268-273
    CrossrefPubMedGoogle Scholar
  • 9 Lillemoe K D, Melton G B, Cameron J L. et al . Postoperative bile duct strictures: management and outcome in the 1990s.  Ann Surg. 2000;  232 430-441
    CrossrefPubMedGoogle Scholar
  • 10 Boerma D, Rauws E A, Keulemans Y C. et al . Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis.  Ann Surg. 2001;  234 750-757
    CrossrefPubMedGoogle Scholar
  • 11 Moore D E, Feurer I D, Holzman M D. et al . Long-term detrimental effect of bile duct injury on health-related quality of life.  Arch Surg. 2004;  139 476-481
    PubMedGoogle Scholar
  • 12 Sarmiento J M, Farnell M B, Nagorney D M. et al . Quality-of-life assessment of surgical reconstruction after laparoscopic cholecystectomy-induced bile duct injuries: what happens at 5 years and beyond?.  Arch Surg. 2004;  139 483-488
    PubMedGoogle Scholar
  • 13 de Reuver P R, Rauws E A, Bruno M J. et al . Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons.  Surgery. 2007;  142 1-9
    CrossrefPubMedGoogle Scholar
  • 14 Aaronson N K, Muller M, Cohen P DA. et al . Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations.  J Clin Epidemiol. 1998;  51 1055-1068
    CrossrefPubMedGoogle Scholar
  • 15 Bergman J J, van den Brink G R, Rauws E A. et al . Treatment of bile duct lesions after laparoscopic cholecystectomy.  Gut. 1996;  38 141-147
    CrossrefPubMedGoogle Scholar
  • 16 Ware Jr J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
    CrossrefPubMedGoogle Scholar
  • 17 Ware Jr J E, Kosinski M, Keller S D. SF-36 physical and mental health summary scales: a user’s manual. 2nd edn. Boston; The Health Institute, New England Medical Center 1994
    Google Scholar
  • 18 Eypasch E, Williams J I, Wood-Dauphinee S. et al . Gastrointestinal Quality of Life Index: development, validation and application of a new instrument.  Br J Surg. 1995;  82 216-222
    Google Scholar
  • 19 Cohen J. Statistical power analysis for the behavioural sciences. New York; Academic Press 1977
    Google Scholar
  • 20 Norman G R, Sloan J A, Wyrwich K W. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.  Med Care. 2003;  41 582-592
    CrossrefPubMedGoogle Scholar
  • 21 Sloan J A, Cella D, Hays R D. Clinical significance of patient-reported questionnaire data: another step toward consensus.  J Clin Epidemiol. 2005;  58 1217-1219
    CrossrefPubMedGoogle Scholar
  • 22 Guyatt G H, Cook D J. Health status, quality of life, and the individual.  JAMA. 1994;  272 630-631
    CrossrefPubMedGoogle Scholar
  • 23 Quintana J M, Cabriada J, Arostegui I. et al . Health-related quality of life and appropriateness of cholecystectomy.  Ann Surg. 2005;  241 110-118
    PubMedGoogle Scholar
  • 24 Weeks J C, Nelson H, Gelber S. et al . Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial.  JAMA. 2002;  287 321-328
    CrossrefPubMedGoogle Scholar
  • 25 Melton G B, Lillemoe K D, Cameron J L. et al . Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life.  Ann Surg. 2002;  235 888-895
    CrossrefPubMedGoogle Scholar
  • 26 Hunt S M. The problem of quality of life.  Qual Life Res. 1997;  6 205-212
    PubMedGoogle Scholar
  • 27 Kern K A. Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences.  Arch Surg. 1997;  132 392-397
    PubMedGoogle Scholar
  • 28 Hubben J H, Christiaans I. No spectacular rise in claims for medical damages in The Netherlands: 1993-’01 compared to 1980-’90 [in Dutch].  Ned Tijdschr Geneeskd. 2004;  148 1250-1255
    PubMedGoogle Scholar
  • 29 de Reuver P R, Rauws E A, Lameris J S. et al . Medical litigation claims due to bile duct injury in laparoscopic cholecystectomy [in Dutch].  Ned Tijdschr Geneeskd. 2007;  151 1732-1736
    PubMedGoogle Scholar

D. J. Gouma, MD 

Department of Surgery
Amsterdam Medical Center

Meibergdreef 9
1105 AZ Amsterdam
The Netherlands

Email: d.j.gouma@amc.uva.nl

      >