Gall bladder removal (cholecystectomy) is a common surgical procedure in Scottish hospitals.
The vast majority of gall bladders are removed laparascopically otherwise known as keyhole surgery. The laparoscopic method does not require a large incision.
Usually this is an outpatient procedure, which allows the patient to return home the day of surgery, and has a two or three day recovery period.
In removing the gall bladder, the surgeon clips the cystic duct in two places. One is near the cystic duct’s juncture with the gallbladder, and the second is at the cystic duct’s juncture with the common bile duct. The surgeon similarly clips the cystic artery.
The surgeon then transects (cuts) the cystic duct and artery between the two clips. By transecting the cystic duct and artery, the surgeon frees the gall bladder for removal.
The surgeon must find and identify the cystic duct’s juncture with the gall bladder and the cystic duct’s juncture with the common bile duct before transecting the cystic duct. The surgeon accomplishes this by finding the gall bladder and the cystic duct juncture; and then meticulously tracing the cystic duct to its junction with the common bile duct.
The objective is to identify the cystic duct conclusively. The surgeon must not clip the cystic duct or transect it before making conclusive identification of the cystic duct.
Unfortunately, laparoscopic cholecystectomies do not always go as planned.
The most common mistake is that the surgeon clips or cuts the patient’s common bile duct instead of the cystic duct (known as iatrogenic injury). This injury usually requires extensive, complicated and painful surgery to reconstruct the patient’s biliary anatomy.
Once the patient’s biliary anatomy has been reconstructed, there will be a long period of convalescence. Even then the reconstructive surgery does not always mean that the patient is out of the woods.
After reconstructive surgery, the patient is at risk of scarring and stricturing of the reconstructed biliary tract and further reconstructive surgery. In the worst case scenario, the patient can develop liver failure and die
The basic rule is that the surgeon must conclusively identify the cystic duct before clipping or transecting. If the surgeon makes the conclusive identification, the gall bladder injury will not occur.
Often the litigation in which we are involved focuses on that one issue - that the surgeon failed to conclusively identify the cystic duct. As a result, the surgeon may have placed clips across the common bile duct, obstructing the flow of bile or transected the patient’s common bile duct, resulting in the flow of bile into the patient’s abdomen with consequent sepsis.
Unfortunately we also encounter cases where there is a delay in recognising that injury, resulting in a severely weakened patient and a more complicated and protracted recovery.
If you would like to talk to a specialist medical negligence solicitor about your experience with gall bladder surgery, in the first instance please complete a simple Clinical Negligence form.
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