Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment Authors P. R. de Reuver 1 , M. A. G. Sprangers 2 , E. A. J. Rauws 3 , J. S. Lameris 4 , O. R. Busch 1 , T. M. van Gulik 1 , D. J. Gouma 1 Institutions 1 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands 2 Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands 3 Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands submitted 15 November 2007 accepted after revision 28 April 2008 Bibliography DOI 10.1055/s−2008−1077444 Endoscopy 2008; 40: 637±643  Georg Thieme Verlag KG Stuttgart ´ New York ISSN 0013−726X Corresponding author D. J. Gouma, MD Department of Surgery Amsterdam Medical Center Meibergdreef 9 1105 AZ Amsterdam The Netherlands d.j.gouma@amc.uva.nl Original article 637 Introduction ! Bile duct injury (BDI) after laparoscopic cholecys− tectomy causes a major problem in current surgi− cal practice. BDI is associated with reduced survi− val and increased morbidity [1]. Currently, the in− cidence of BDI ranges from 0.5 % to 1.4% [2 ±4] depending on the criteria used to define injury. Measures to prevent and recognize BDI are out− lined in many publications, and several authors report the optimal treatment strategy and short− and long−term outcome [5 ± 9]. Success of treat− ment by gastroenterologists, interventional radi− ologists, and surgeons is described in terms of morbidity, mortality, and costs, and more recent− ly also in quality of life (QoL) [10±12]. However, there are remarkable discrepancies between findings in the various studies. The discrepancies are probably due to differences in the type of treatment, duration of follow−up, and patient population in these studies. Moreover, the sam− ple sizes of patients were relatively limited and only a single assessment of QoL in time was per− formed. Generic instruments for assessment of QoL were used in these studies, and specific changes due to the gastrointestinal disorders could therefore not be assessed. A disease−specif− ic instrument could identify physical, emotional, and social dysfunction related to the gastrointes− tinal complication and its treatment. In view of the above limitations and discrepant outcomes, the aim of the present study is to an− swer the question, “Does BDI has a detrimental effect on long−term QoL in patients who under− went multidisciplinary treatment with a good functional outcome?”. Long−term generic and disease−specific QoL will be assessed in a large number of patients with BDI treated by gastroen− terologists, interventional radiologists, and sur− geons. The results will be compared with control data from patients who underwent an uneventful laparoscopic cholecystectomy and from the gen− 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 de− termined. Patients and methods: In March 2005 a survey was performed of 403 eligible patients with BDI who were referred to a tertiary center for multi− disciplinary treatment by gastroenterologists, radiologists, and surgeons. A longitudinal quali− ty−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 out− come of injured patients was significantly lower in three of the eight domains compared to pa− tients who underwent cholecystectomy without an injury (P < 0.05). In seven of the eight QoL do− mains 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 re− ported 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 out− come of a malpractice litigation claim is associat− ed with QoL. De Reuver PR et al. Impact of bile duct injury after laparoscopic cholecystectomy ¼ Endoscopy 2008; 40: 637 ± 643