Abstract
Objective. To compare the quality of life of patients with spontaneous internal biliary fistula (SIBF) and without them, before and after surgery.
 Materials and methods. 82 (38.7%) patients were diagnosed with Mirizzi syndrome (MS) type I, and 130 (61.3%) patients with type II (II-V) type MS. During the study, the classification of A. Csendes - M. Beltran was used. By sex, patients were distributed as follows: there were 68 men (32.0%), women - 144 (68.0%). The age of patients ranged from 37 to 80 years (average - 66.4 years). The GSRS (Gastrointestinal Symptom Rating Scale) questionnaire was used to assess quality of life. When comparing groups, the use of Student's T test comparative mean values and quadratic deviations. The reliability of the obtained p values were checked by the method of Bonferoni and False Discovery Rate (FDR).
 Results. Multiple comparisons with Bonferon and FDR correction revealed statistically significant differences in the results between QOL of patients with MS I and II both before and after surgery. When compared on the scale of total measurement, it was found that the quality of life of patients without SIBF improved by 11% after cholecystectomy in MS I type. When comparing the results of QOL assessment before and after surgery in patients with type II MS, it was found that QOL after surgery in patients improved by 10% from baseline.
 Conclusions. The quality of life of patients with MS I type is higher compared to patients with SIBF both before and after surgery (p=0.0001), which is due to impaired bile duct and gastrointestinal tract in SIBF. Elimination of SIBF improves the level of QOL of patients by 10%, which is characterized by a decrease in all items of the GSRS scale.
Highlights
Choledocho–duodenal fistulas, found in 22 patients according to fibroduodenoscopy, we divided into two types depending on the location
In 19 patients the fistula was located in the border of the transitional fold of the large duoȱ &KROHF\VWHFWRP\IURPWKHERWWRPVXWXULQJRIZLGHDQGVKRUWYHVLFDOGXFWV &KROHF\VWHFWRP\IURPWKHQHFN
With formation of Mirizzi syndrome (MS) there are new functional relationships, which greatly impact the function of both – the biliary system and gastrointestinal tract (GIT), as they on a "parity" basis are involved in the fistula formation
Summary
Analysis of the examination results in 8100 patients with a gallstone disease, treated in the Transcarpathian Regional Clinical Hospital named after Andriy Novak in 1997 – 2020 yrs, of whom in 212 (2.5%) the MS was diagnosed, including the disease Type I – in 82 (38.7%), and Type II (II–V) – in 130 (61.3%). The study used the classification of A. QOL was assessed, using the GSRS (Gastrointestinal Symptom Rating Scale) questionnaire, developed by the QOL Study Division at ASTRA Hassle 1998) and applied for the QOL estimation in patients with gastrointestinal disease [6]. The translated version of the GSRS questionnaire was considered a reliable, valid and sensitive. The indicators were estimated by a score of 1 to 7, with higher values, corresponding to greater severity of symptoms and lower QOL. For statistical analysis we have applied a software package Microsoft Exel 2019 and Jamovi 1.6.14. Student's T–test was used to compare QOL values, namely – the mean values and square deviations. The validity of the P values obtained was checked using the Bonferoni correction and the False Discovery Rate (FDR) method
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