Gallbladder Surgery Malpractice
Laparoscopic cholecystectomy (gallbladder removal) became popular in the late 1980s, and quickly became one of the most common surgical procedures in America. More than 750,000 “lap chole” procedures are performed every year. Unfortunately, the complication rate for laparoscopic cholecystectomy remains higher than the complication rate for open cholecystectomy.
The most common complications related to medical malpractice include bile duct injuries, excessive bleeding, bowel perforation, and diathermy burns to the hepatic ducts. Below are descriptions of many of the most common types of malpractice we have seen in our legal work.
Cutting The Hepatic Duct Or Bile Duct: Doctors are trained to visualize a patient’s anatomy during a surgery, and to never cut if they’re not sure what they’re cutting. Yet, many surgeons, in a rush to complete the operation, make assumptions about a patient’s anatomy and simply start cutting. For example, many times the surgeon accidently cuts the common hepatic duct instead of the cystic duct. As another example, sometimes the surgeon accidently plays surgical clips on the common bile duct, causing a stricture.
There are five many types of “biliary” injuries, or injuries to the bile duct:
- Type A involves an injury to the cystic duct or from minor hepatic ducts draining the liver bed
- Type B involves an occlusion to the biliary tree, often the right hepatic duct
- Type C involves a transection without ligation of the right hepatic duct
- Type D involves a cut to the major bile cut
- Type E involves a cut to the main hepatic duct
These injuries are usually avoidable, and are typically caused because the surgeon cut without being able to see what they were cutting. Surgeons are trained to remove all tissue except for the cystic duct and artery, so they can see the liver bed and then carefully identify all structures between the gallbladder and liver. These safety procedures are so important that doctors are supposed to document them when they perform them.
Failing To “Convert” The Laparoscopic Procedure To An Open Surgery: There are methods for discovering complications during the procedure, such as a use of a cholangiogram. Between 2% and 15% of lap chole procedures are “converted” to an open procedure, most commonly because of acute cholecystitis, when bile becomes trapped in the gallbladder. If these complications are identified correctly, then a recovery procedure can begin, like an ERCP (endoscopic retrograde cholangiopancreatogram) under anesthesia with stents. Yet, doctors often ignore the signs of a problem and complete the surgery. When that happens, the patient can develop severe complications from the untreated injury including infection, cholangitis, sepsis, and death.
Trocar Errors: A “trocar” is a short surgical instrument used for opening space and removing fluid. Trocars, however, have to be used with the utmost care, and many times surgeons or surgical residents negligently insert the trocar, causing damage to other areas. More trocar injuries occur during laparoscopic cholecystectomy than any other procedure. A trocar insertion into the retroperitoneal space, for example, can injury the iliac vein, causing severe bleeding that requires bringing in a vascular surgeon and converting the surgery to a procedure that can fix the injury.
Bleeding Injuries: Up to 2% of lap chole procedures cause uncontrollable bleeding, typically from the liver, the arteries, or from the ports where the laparoscopic tools are inserted. Liver bleeding typically occurs at the end of the surgery, when the gallbladder is being removed, and it requires immediate conversion to an open procedure. Bleeding from arteries or veins often occur because of dislodged surgical clips or because of reckless movement of the laparoscope. The key issue in both is rapid identification of the injury: if they are not spotted quickly and treated with resuscitation, transfusions, and reoperation, then the bleeding can quickly get worse and cause far more severe problems, including infection, sepsis, and death.
Stomach Or Bowel Perforation: Bowel injuries occur in less than 1% of cases, almost always due to malpractice. Careless use of the trocars or the laparoscope can puncture the stomach, bowel, jejunum, or ileum, causing severe injuries. When these injuries happen, the patient is at a severe risk of several potentially fatal complications, including abdominal compartment syndrome, and it often takes several surgeries to stabilize the patient again.