Document Detail


Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life.
MedLine Citation:
PMID:  12035047     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the quality of life (QOL) of patients after surgical reconstruction of a major bile duct injury from laparoscopic cholecystectomy (LC).
SUMMARY BACKGROUND DATA: The incidence of bile duct injuries has increased dramatically since the introduction and widespread use of LC. Previous reports show that at long-term follow-up, most patients surgically repaired will have a successful outcome as measured by standard clinical parameters. However, there is a general impression that these patients have an impaired QOL. Data addressing QOL of these patients are limited.
METHODS: A standard QOL questionnaire was sent to 89 patients after successful surgical repair of a major bile duct injury from a LC treated at the Johns Hopkins Hospital between 1990 and 2000. The instrument consisted of 30 items on a visual analog scale categorized into physical (15 items), psychological (10 items), and social (5 items) domains. The same questionnaire was sent to age- and sex-matched healthy controls (n = 100) and to patients who underwent uncomplicated LC (n = 100). An additional portion of the questionnaire inquired about outcome measures and legal action undertaken by patients.
RESULTS: Overall QOL scores for bile duct injury patients in the three domains (physical, psychological, and social) were 76%, 77%, and 75%, respectively. QOL scores were comparable to those of patients undergoing uncomplicated LC and healthy controls in the physical and social domains but were significantly different in the psychological domain. Presenting symptoms, prior repair, level of injury, number of stents, length of postoperative stenting, and length of follow-up did not influence QOL scores. Repaired patients reported similar rates of abdominal pain, change in bowel habits, use of pain medications, and recent symptoms of fever or chills as LC controls. Thirty-one percent of responding bile duct injury patients reported having sought legal recourse for their injury. All QOL domain scores were significantly lower in the patients who pursued a lawsuit versus those who did not.
CONCLUSIONS: This study provides formal data evaluating QOL after surgical repair of major bile duct injuries from LC. Although there was a significant difference in the QOL as evaluated from a psychological dimension, bile duct injury patients reported QOL scores in the physical and social domains comparable to those of control patients. The decreased QOL assessment in the psychological dimension may be attributable to the prolonged, complicated, and unexpected nature of these injuries. The presence of a lawsuit appears to be associated with a poorer QOL assessment.
Authors:
Genevieve B Melton; Keith D Lillemoe; John L Cameron; Patricia A Sauter; JoAnn Coleman; Charles J Yeo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  235     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-05-29     Completed Date:  2002-06-19     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  888-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Roux-en-Y
Bile Ducts, Extrahepatic / injuries*,  surgery*
Catheters, Indwelling
Cholecystectomy, Laparoscopic / adverse effects*,  legislation & jurisprudence
Female
Humans
Intraoperative Complications / surgery*
Liability, Legal
Male
Medical Errors* / legislation & jurisprudence,  psychology
Middle Aged
Quality of Life* / psychology
Stents
Treatment Outcome
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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