MULTIMODAL MANAGEMENT OF BILE DUCT INJURIES AND ITS IMPACT ON QUALITY OF LIFE

Aim: The aim of this study is to present long-term results of endoscopic and surgical management of patients with bile duct injury (BDI) and the impact of such injury on quality of life. Patients and methods: Patients with BDI during the period 2000-2004 received either endoscopic or surgical therapy according to the type of BDI diagnosed at ERCP. Patients were clinically, laboratory, ultrasonographicaly follozvcu-up to assess the functional outcome of such multimodal management. The SF-36 quality of life questionnaire was used to assess their quality of life and was compared with a matched control group ivho had undergone an uncomplicated cholecystectomy. Results: Surgical, endoscopic, and combined management was offered to 17 (53%), 12 (37.5%), 3 (9.5%) patients, respectively. Management outcome was excellent to good in 19 (59.4%) patients and fair in 13 (40.6%) patients. Biliary leak was encountered in 4 (21.1%) postoperative and liver abscess in one patient post-endoscopic treatment. A total number of 8 (25%) patients required reintervetion as a result of initial treatment failure or restenosis. Analysis of actuarial survival in relation to type of injury, type of management and management outcome revealed that outcome was the only factor that significantly affected survival. Quality of life of all patients regardless of outcome was significantly lower than corresponding patients with uncomplicated cholecystectomy. Conclusion: Although good functional outcome with no mortality can be achieved from multimodal management of patients with BDI, long-term results are characterized by recurrent morbidity, short survival, and a low quality of life