This case involves a middle-aged male patient in Wyoming who was morbidly obese patient who suffered from an infected surgical incision following surgery. The patient presented to a general surgeon for what was initially supposed to be a routine gallbladder removal surgery performed with a traditional incision. The surgery proceeded without complications and the patient was discharged home. However, less than a week after the surgery was completed the patient returned to the hospital to have his stitches removed at which point the wound completely opened. Over the next few days, the wound became infected. The patient was forced to endure an extended stay in the hospital, and was left seriously disfigured.
Question(s) For Expert Witness
- 1. Do you routinely perform this procedure?
- 2. Do you frequently leave staples in longer than one week for such a procedure?
Expert Witness Response E-008057
I routinely perform this procedure, on average 1 to 2 cases per week. Closures on the abdomen should be left in on average 10 to 14 days, and a vigilant eye should be kept on the patient’s progress in order to identify the development of infection. I have significant experience in both open and laparoscopic cholecystectomy. In addition, I have fellowship training in bariatric surgery dealing with patients like the one described here with morbid obesity. I am an assistant professor of surgery at a major teaching university hospital focusing on upper GI and general surgery. I am also an associate program director for the general surgery residency.
Expert Witness Response E-001161
As a board-certified general surgeon, I routinely operate on similar patients. In the case of wound infection, certain guidelines need to be followed to prevent complications such as the one presented. For example, if there is gross bile spillage or contamination from the procedure, the patient should have been washed out intrapoeratively, and antibiotics should have been administered for at least 7-10 days. Oftentimes in this the wound should be left open. Failure to adhere to these guidelines may represent a deviation in standard of care and result in an unnecessary complication.