Laparoscopic Cholecystectomy
Cholecystectomy is the removal of the gallbladder and is usually performed because a patient is suffering from symptoms caused by an inflamed or infected gallbladder. Most cholecystectomies are completed laparoscopically (“lap chole”). To access the gallbladder during a lap chole, the surgeon places instruments through several small incisions and views the surgical field via a video camera. The surgeon then carefully removes the gallbladder from its attachment to the liver, clips and transects the cystic duct and artery, and removes the gallbladder through one of the incisions. Lap choles are currently being performed at a rate of approximately 750,000 per year in the United States.
Cholecystectomies were first performed laparoscopically in the United States in 1989 and the technique was widely adopted by 1992. Despite advances in technique and experience with the procedure, lap chole carries a 2.5% risk of serious complication. The frequency with which lap choles are undertaken means that a large number of patients seek information as to whether they may bring a medical malpractice claim to recover for damages suffered from surgical complications.
The most common errors during lap chole involve failure to properly identify the anatomy of the biliary system and inadvertent cutting of adjacent structures. The biliary system is a series of ducts that serve the gallbladder, liver, and pancreas. Lap chole cases commonly involve the transection of the common bile duct rather than the cystic duct or the clipping or laceration of the common bile or hepatic ducts. Surgeons have an affirmative duty to positively identify the relevant anatomy before clipping or transecting any structure. If the anatomy is unclear, the surgeon has several options, including intraoperative cholangiogram (a radiology study that delineates the biliary structures), consultation with a colleague, and conversion to an open procedure. Once the anatomy has been positively identified, the surgeon must use care to avoid clipping or otherwise injuring adjacent structures. Lap chole injuries require repair and reconstruction by a specialist and can result in long periods of hospitalization and recovery.
Surgical errors during lap chole procedures are often compounded by the failure of the surgeon or other treating medical providers to recognize the signs and symptoms of complications. In the days following the surgery, patients with bile leaks often complain of abdominal pain, persistent nausea and vomiting, and fever. Since most lap chole patients leave the hospital within twenty-four hours after surgery, those who do not improve quickly following surgery should be monitored very closely. Failure to promptly recognize these injuries and arrange for repair can result in additional complications from bile peritonitis.
There is a misconception among attorneys that the complications of laparoscopic cholecystectomy may not be the basis for medical negligence claims. In 2008, Judge John A. Woodcock of the United States District Court for the District of Maine issued a decision in favor of a surgeon who had injured a patient’s hepatic duct. This opinion misinterpreted the relevant medical literature and techniques available to prevent such an injury, suggesting that injury to the hepatic duct is an accepted risk of the procedure. At Berman & Simmons, we continue to obtain favorable settlements in lap chole cases. Among these settlements are cases that were rejected or abandoned by other attorneys. We are able to designate highly qualified expert witnesses in support of our position, including professors of surgery at major universities.
As with any medical negligence case involving general surgery, the evaluation of a lap chole cases requires consideration of the following:
- The nature of the surgical error and/or the structure injured. This information is often available from the potential client or the operative report of the subsequent treating surgeon.
- Whether the surgeon or other providers reacted in a timely and appropriate manner to the signs and symptoms of the injury. Potential clients sometimes report that their complaints were ignored or that the surgeon did not follow them closely during their hospitalization.
- The damages suffered by the patient. While the prosecution of lap chole cases requires the assistance of expensive expert consultants, the full extent of damages suffered may not be apparent without evaluation by an attorney with experience handling these claims.
Berman & Simmons attorneys are available to evaluate laparoscopic cholecystectomy cases at any stage, and early referral for case analysis increases the likelihood of successful and rapid resolution.