More than 90% of gallbladder surgeries are now done laparoscopically. This procedure is one of the most frequently performed surgeries in the United States. Unfortunately, improperly performed laparoscopic surgeries occur. Some unskilled doctors are performing this surgery, with terrible consequences for their patients. Also, skilled doctors may cause injuries during this surgery due to medical malpractice. If these errors are not recognized and treated immediately, they can result in serious injuries or death.
The Laparoscopic Gallbladder Surgery Procedure
The gallbladder is a small organ whose function is to store and release bile, which is a digestive fluid secreted by the liver. Bile performs the critical function of breaking down fats so they can be absorbed by the digestive tract.
Gallbladder removal surgery is usually performed when gallstones have formed in the gallbladder, blocking the flow of bile and causing pain.
Traditional (Open) Gallbladder Surgery
In a traditional gallbladder surgery, known as “open cholecystectomy”, a large incision is made just below the ribs on the right side of the abdomen. The liver is moved to expose the gallbladder. The blood vessels and ducts to and from the gallbladder are cut and clipped, and the gallbladder is removed. The patient is under general anesthesia for the procedure.
Laparoscopic Gallbladder Surgery
During a laparoscopic gallbladder surgery, a small incision is made in the abdomen and a hollow tube called a trocar is inserted through the incision into the abdominal cavity.
A video camera is then inserted through the trocar. The camera is connected to a television monitor in the operating room and the surgery is performed using the TV monitor to guide the surgeon. Several small incisions are made in other areas of the abdomen and trocars are inserted into the abdominal cavity.
Small surgical tools, including scissors, forceps, graspers and other instruments, are advanced through the trocars to perform the surgery. The ducts, arteries and other anatomical attachments to the gallbladder are cut and clipped, and the gallbladder is removed.
The surgeon must correctly identify each duct and artery and be sure he or she is cutting and clipping the proper ones. Mistakenly cutting, clipping or nicking the common bile duct, for example, rather than the cystic duct can lead to serious injury or death, as can nicking or cutting adjacent organs.
The steps in the surgery include:
• Administration of general anesthesia to the patient.
• The abdomen is inflated with carbon dioxide to create enough space that the surgeon can see and maneuver inside the abdominal cavity.
• Several small incisions are made, including one in the naval.
• A laparoscope is inserted, which is attached to a camera, allowing the doctor to see inside the abdomen and identify the ducts and organs.
• Using the camera and TV screen as a guide, surgical instruments are inserted through the other incisions. These instruments are used to cut the ducts and blood vessels and place small metal clips on them.
• The gallbladder is separated from the liver and the gallbladder is removed.
• Finally, the carbon dioxide is removed from the abdomen and the incisions are closed with stitches.
The organs and ducts involved in laparoscopic gallbladder surgery are small and close together. The surgeon is working by television camera rather than by direct vision and direct contact. For these reasons, laparoscopic surgery must be performed carefully, by a well-trained surgeon, or terrible consequences can result. An injury that can occur during the procedure is the cutting of the common bile duct or common hepatic duct. It is essential for the surgeon to be careful in properly identifying the ducts he/she intends to cut and be absolutely certain that he or she is cutting and clipping the proper one. If the bile duct is mistakenly cut during the surgery, bile will seep into the abdominal cavity and this can cause serious injury or death. Also, cutting or lacerating another organ, such as the intestine (bowel) can cause serious injury or death.
The gallbladder is connected to the common bile duct through the cystic duct. Injuries also occur when the surgeon improperly attaches the clips to the cystic duct.
Improperly performed laparoscopic gallbladder surgery can lead to bile leakage, infection, bile peritonitis, abscess and death. Biliary duct injuries caused by surgeons can be devastating and sometimes fatal.
In addition, the common bile duct or hepatic duct can be damaged during the surgery, causing strictures or narrowing of the duct. Despite corrective surgery, the patient may continue to suffer permanent pain and/or digestive problems as a result.
Another problem after injury is cholangitis, an infection or inflammation of the bile ducts, causing bacteria and other waste products in the small intestine to flow upward causing infection. Cholangitis can be life-threatening if not treated.
Bile peritonitis (bile leaking into the abdominal cavity) and/or infection can lead to organ failure and death, and must be acted upon immediately. Again, immediate surgical action must be taken to prevent serious injury or death.
This is one of the most commonly performed surgeries in the United States, and sometimes unskilled doctors undertake the procedure without proper experience and training, putting their patients at risk and causing serious harm.
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