Long-term outcomes and quality of life after repair of benign biliary stricture of post-cholecystectomy bile duct injury.

Abstract

Introduction: Bile duct injury (BDI) is a potentially devastating complication of cholecystectomy. Although the repair may be successful, patients often experience a decline in their quality of life (QoL). However, there is a paucity of data regarding the factors influencing long-term outcomes and QOL in these patients.

Methods: Patients who underwent benign biliary stricture (BBS) repair with at least three years of follow-up were assessed for inclusion in the study. Long-term outcomes were assessed with MacDonald Grading. QOL assessed using the SF-36 questionnaire, with a control group of patients who had uncomplicated laparoscopic cholecystectomy (LC).

Results: Of 156 patients screened, 41 were included in the study, with a median follow-up duration of five (IQR 4.8) years. Successful long-term outcomes with MacDonald outcome grade A were observed in 28 (68.3%) patients, 12 (29.2%) patients had grade B and one (2.4%) had grade-D outcomes. External biliary fistula at the time of repair had grade-D outcome in one patient (14.2%) and grades B and A in three (42.9%) patients each. The higher strictures (types IV and V) were associated with higher MacDonald grade-B outcomes compared to types I-III strictures (7 [53.8%] vs. 5 [17.9%]) , whereas lower strictures were more likely to have grade-A outcomes as compared to higher strictures (22 [78.6%] vs. 6 [46.2%] [p = 0.044]). Patients with BDI repair reported significantly lower scores in all eight SF-36 domains compared to controls (p < 0.05).

Conclusion: The long-term outcomes of delayed BBS repair are favorable in high-volume center. Despite the acceptable post operative clinical outcomes, the long-term QOL remains compromised after BBS repairs.