This case involves a middle-aged male patient who presented to the emergency room with occasional gastric pain that had persisted for several months. A CT scan showed that the patient was suffering from a disorder in his gallbladder and the decision was made to operate. While doctors initiated the procedure laparoscopically, when mobilizing the gallbladder was attempted, bleeding was encountered that forced surgeons to switch an open incision. During the procedure, multiple branches of what was thought to be the portal vein were tied off. They further mobilized the gall bladder and divided the cystic duct. An intraoperative cholangiogram was obtained and it was evident the common bile duct had been divided. It could not be safely repaired and an additional surgery was performed. As a result, the patient suffered significant injuries and required an extended hospital stay.
Question(s) For Expert Witness
- 1. How often do you perform laparoscopic cholecystectomies?
- 2. What care is taken to avoid injury to branches of the portal vein and transection of the common bile duct?
Expert Witness Response E-070753
Injury to the common bile duct is a dreaded complication, which occurs 1-3 times per 1000 cholecystectomies. General surgeons perform about 600,000 cholecystectomies a year in this country, and it is a procedure I perform on a fairly regular basis. Safety in cholecystectomy revolves primarily around the critical view of safety, which is a dissection technique that identfies the critical anatomic structures to be divided and ensures the safe preservation of the common bile duct and hepatic/portal vasculature. I have seen this injury. Data shows that repair by roux-en-Y choledochojejunostomy is best left to experienced hepatobiliary surgeons. If possible, revascularization of injured vessels by a vascular surgeon should be attempted. Informed consent for laparoscopic procedures, which make up a vast majority of my practice, should include discuss of the possibility of open surgery.