What Are the Long-term Clinical and Economic Consequences of Delayed Biliary Strictures after Cholecystectomy?

Abstract

Introduction: Delayed biliary stricture after cholecystectomy is a rare complication for which little is known of the aetiology or long-term clinical and economic consequences. The aims of this study were to investigate the risk factors, clinical outcomes and economic impact of this rare but serious complication. Method: Patients who developed a delayed biliary stricture after cholecystectomy were identified from a prospectively collected and maintained database. Risk factors for stricture development, long-term biliary complication rates, quality of life and complete treatment and follow-up costs were investigated for each patient. Results: Some 44 patients were identified, of whom N=17,12 and 3 developed hilar, subhilar, and sectoral biliary strictures respectively. Patients were commonly treated with Roux-en-Y hepaticojejunostomy (90%) and followed up for a median of 8.9 years (IQR5.8-14.8) during which time 16 (36%) developed biliary complications and 5 (11%) patients died. Costs of all operations, interventional radiology and diagnostic imaging were assimilated and the mean cost of treatment and follow-up was £14,309.26 per patient, similar to previously reported costs for major bile duct injury. Both general and disease-specific quality of life were assessed using the SF-36 tool and EORTC QLQ-C30 with Bil21 add-on. Scores were statistically similar for patients with delayed biliary stricture and those with bile duct injury. Conclusions: Delayed biliary strictures may develop after uneventful cholecystectomy and are typically managed with biliary reconstruction. They are serious complications that lead to considerable long-term morbidity and costs to the health service, similar to those previously reported for major bile duct injury.