Common Bile Duct Injuries Continue To Occur At Alarming Rate In Laparascopic Surgery For Removal Of Gallbladder

Mar 20, 2007 — by Gary Zucker
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One of the most common medical malpractice cases at Gary A. Zucker & Associates, P.C. involves injury to the common bile duct during surgical removal of the gallbladder. Since 1990, when laparoscopic cholecystectomy was approved, it has grown in popularity and is currently the most common surgery performed in the United States for removal of the gallbladder. This surgery has obvious advantages over the open surgery where a large incision is made and the abdomen opened. Laparoscopic surgery entails four very small incisions through which instruments and a camera are placed and allows the surgeon to view the gallbladder and surrounding structures on a television monitor which magnifies the image to 12 times its normal size. Surgical clips are then placed on the cystic duct which connects the gallbladder to the common bile duct. One clip is placed at the base of the gallbladder where it connects to the cystic duct and a second clip is placed at the other end of the cystic duct where it connects to the common bile duct. A cut is made between the two clips and the gallbladder is removed through the umbilicus (the belly button). Foremost among the concerns of the surgeon is to avoid mistakenly cutting the common bile duct rather than the cystic duct. It is this surgical error that has been the basis of many malpractice claims that we have successfully handled at Gary A. Zucker & Associates, P.C.. In truth, there is no excuse for this error. Surgeons are taught in their training that if there is any doubt as to whether they have correctly identified the cystic duct, they should cease doing the surgery laparoscopically and convert to an open surgery. The surgeon can only be certain that he has identified the cystic duct if he can clearly see the connection between the end of the duct and the base of the gallbladder. This requires that the surgeon dissect (cut away) the gallbladder from the surrounding tissue. However, because of variations in anatomy (only 25% of patients have the classic anatomy) and because of inflammation that frequently occurs in acute flareups, it may be difficult to clearly visualize this junction. Thus, all surgeons routinely obtain consent from the patient preoperatively to convert to an open procedure in the event there is difficulty identifying the junction between the cystic duct and the gallbladder. In its March 12, 2007 issue, Newsweek reports that 1 in 200 patients undergoing this surgery sustain serious injury due to the surgeons error in cutting the common bile duct rather than the cystic duct. Even more alarmingly, many patients sustain further injury due to inadequate repair of the common bile duct after the initial injury occurs. Whereas it was previously common to perform a repair by simply sewing the severed bile duct back together (a primary repair), it has been found that this frequently causes stenosis (narrowing) of the bile duct with a resultant blockage of bile flow to the intestine and a backup of bile into the liver which, in turn, can lead to liver failure and death. Thus, a Roux-en-Y repair is now preferred whereby a new connection is made in order to circumvent the blockage. Many surgeons who are untrained or unskilled in this repair nevertheless attempt to perform the repair themselves rather than call in an appropriately trained specialist. If you or a family member have been injured during laparoscopic gallbladder removal surgery, please call our medical malpractice lawyers at Gary A. Zucker & Associates, P.C. for a free consultation or contact us through our website at www.gazassociates.com.

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