Quality-of-life after bile duct injury: intraoperative detection is crucial. A national case-control study

Abstract

Background: Existing reports on quality-of-life (QoL) after bile duct injury (BDI) are conflicting.

Routine intraoperative cholangiography during cholecystectomy is a cost-effective approach when analysing the cost of iatrogenic bile duct injuries

“…The mail-survey including the study-specific questionnaire and EQ-5D was returned by 61% (312 of 512) of all participants 64% of patients with a BDI (107 of 168), and 60% in the control group (205 of 347). 14 The responders and non-responders with BDI were similar with respect to matching criteria, as shown in Table 2S (supplementary on-line).…”

“…SPAR is updated daily and data presented in this report were retrieved through October 2013, the same month the questionnaires were distributed by mail to the participants. 14 Missing data for yearly sick leave and monthly income for patients with BDI up to the age of 65 were imputed by performing calculations on official Swedish statistics for the year 2013 when mean yearly sickleave in Sweden was 10.0 days for women and 5.2 days for men. 21 Health status (EQ-5D) The EuroQol Group is an international network of multidisciplinary researchers that developed EQ-5D as a standardized measure (utility value) of health status, i.e.…”

“…5,12 Studies on QoL after BDI have shown diverging results, but postoperative diagnosis and prolonged treatment have proven to be factors associated with poor outcome. 14,15 In a costeffectiveness analysis of early versus late reconstruction of BDIs, early repair by a hepatobiliary surgeon was the superior strategy. 8 In Sweden, approximately 12,500 cholecystectomies are performed annually and registered in GallRiks, a national quality register for all gallstone surgery.…”

“…16 Treatment and clinical outcome as well as QoL measured by SF-36 for the cohort of patients with BDI reported in this paper, have previously been published. 5,14 The aim of this study was to evaluate the direct and indirect costs associated with the treatment of cholecystectomy-related BDIs in relation to when the injury was diagnosed and treated. The cost effectiveness for routine versus on-demand intraoperative cholangiography at cholecystectomy was also estimated (ICER-incremental cost effectiveness ratio).…”

Surgical management for bile duct injury

“…The ideal repair or reconstruction procedure should be carried out without inflammation (34). Based on this principle, intraoperative BDI are suggested to be repaired immediately by experienced biliary surgery specialists (35). If it cannot be performed with the support of specialists, patients should be treated with drainage and referred to specialist hospitals for early repair (36,37).…”