Approximately 700,000 Americans have their gallbladders surgically removed each year, with most of them being done by a minimally invasive procedure called a laparoscopic cholecystectomy or lap-choly. The procedure is performed by the use of small incisions, and the insertion of a camera and small surgical instruments. Most commonly the gallbladder is grasped with the operating tools and the surgeon dissects his way from the gallbladder towards a tube called the cystic duct. Once the cystic duct is identified, it is clipped with small surgical clips and the gallbladder is removed.
Bile, which is produced in the liver and concentrated in the gallbladder, helps in the digestion of fatty foods. Bile reaches the gallbladder though tube-like structures called ducts. Ducts leaving the liver meet to form the common bile duct(CBD) and the cystic duct connects the common bile duct to the gallbladder. Injury to the ducts leaving the liver, or to the common bile duct, are preventable injuries that can be catastrophic. Patient safety requires that avoiding bile duct injury should be the surgeon’s primary goal. Studies have shown that misidentification by the surgeon of the ductal structures is the most common reason for these injuries. While it is a truism that a surgeon must never clip or cut a structure unless he is absolutely sure of what the structure is, nevertheless, common bile ducts are misidentified as cystic ducts at an alarming rate.
When a surgeon encounters any difficulty whatever in correctly identifying the ductal structures, it is easy to convert the procedure into an open one. This simply requires removing the laparoscopic instruments and then making a larger incision. The larger scar and longer recovery time pale in comparison to the adverse effects of bile duct injury, and should never prevent the surgeon from converting to open.
Another problem is that the majority of injuries are not recognized at the time of surgery and repair is delayed. If a cholecystectomy is difficult, it is prudent for the surgeon to get an intra-operative consultation from an experienced surgeon, both to avoid the injury or to recognize that it has occurred.
The treatment of these injuries is complex, requiring a team of experienced surgeons and clinicians, and there should be no hesitation in transferring a patient to a tertiary care center when ductal injury is suspected.
Before undergoing surgery, make sure your surgeon is board certified. Ask how many procedures he does every year-the more the better. If this injury happens to you, make sure you place yourself in the hands of a highly experienced surgeon, and later, a highly experienced lawyer.
Lap Choly Malpractice – Errors during Gall Bladder Surgery can be deadly
When any minimally invasive surgery such as Laparoscopic Cholecystectomy is successful, it can be a real blessing. When it is not, it can be a personal and family catastrophe. Our job is to help you sort out laparoscopic cholescystectomy malpractice from unpreventable problems.
Because laparoscopic surgery is done using a television camera and instruments, some surgeons find it difficult to orient themselves to the gall bladder and other organs. This can lead to cutting or damaging the common bile duct or hepatic ducts. Cutting or damaging these important structures can lead to bile leak, infection, bile peritonitis, abscess and death. In addition, the common bile duct may become so narrowed that extensive dilatation or reconstructive surgery is needed. Some patients are left with permanent pain and serious digestive problems.
Leaking of bile usually causes symptoms of pain and breathing difficulties, and any symptoms that might be due to a bile leak must be taken seriously by the surgeon and investigated. The failure by the health care providers to take the patients complaints seriously, and quickly act, is a prime example of malpractice. All too often the patient is discharged from the hospital despite evidence of a bile leak.