This OR operations case involves an elderly male patient in Mississippi who underwent surgery for a laparoscopic repair of a hernia using Composix mesh. The procedure involved extensive removal of adhesions; at some point during the surgery, a small bowel perforation occurred that was not recognized intraoperatively. A few days after the procedure, a CT scan of the abdomen and pelvis revealed a probable bowel perforation. He was taken back to the operating room for emergency surgery, at which point a small bowel perforation was discovered and easily repaired. However, the patient then developed abdominal compartment syndrome, at which point he was transferred to another facility for additional care. The patient was hospitalized for months, and remains severely debilitated following the surgery.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?
Expert Witness Response E-001161
As the Director of the comprehensive cernia center at a top university affiliated medical center, I regularly perform laparoscopic hiatal hernia repairs. Although bowel injuries are a known complication of this procedure, there is a standard of care that must be met to ensure that the complication is not missed, and is treated in a timely manner. From the summary, there is concern that there was a delay in diagnosis and a delay in treatment for taking several days to find out that there was a perforation. Furthermore, there is potentially an inappropriate treatment rendered that may have led to further complications such as abdominal compartment syndrome.
Expert Witness Response E-001188
I am a board certified general surgeon and I perform approximately 100 laparoscopic lysis of adhesions a year. I have never had a patient develop this outcome during isolated hiatal hernia repairs, but I have had enterotomies discovered intraoperatively during lysis of adhesions. My guess is that this is related to the lysis of adhesions and has nothing to do with the hiatal hernia repair. It is somewhat questionable if there is truly a deviation here. This would depend, at least in part, on the degree of delay in the recognition of the complication.