When it Comes to Laparoscopic Surgery, Complications Arise or Doctors are Negligent
Patients undergoing laparoscopic cholecystectomies (gallbladder surgeries) naturally have to rely upon their surgeon to perform the procedure in a safe manner, and most of the time, this goal is met. But there are occasions when complications arise or doctors are negligent, resulting in serious injury to the patient. In these circumstances, it is important to understand what went wrong during the surgery to determine if the bad result was a normal risk or was caused by the medical negligence of the surgeon.
Laparoscopic cholecystectomies are performed under general anesthesia, meaning that the patient is unconscious when the procedure is performed. For this reason, when assessing the cause of a bad result, the medical records are the first place to investigate. The medical records, though, are controled by the medical care providers, so reviewing the records from the laparoscopic cholecystectomy (often abbreviated as “lap choly”) alone is often insufficient, since doctors who have committed malpractice may not have realized it at the time of the operative report or may have chosen to omit certain facts that would be relevant to our analysis. Therefore, we also review the medical records for the post-operative care, including any revision surgeries or ERCPs (endoscopic retrograde cholangiopancreatography). Usually, from a combination of the operative records and the post-operative care, we can get a more complete picture of what ultimately went wrong during the initial lap choly and determine whether the bad result was caused by medical malpractice.
Every Laparoscopic Cholecystectomy Surgery is Unique
Every case is unique, but there are certain factors that strongly indicate malpractice when reviewing a lap choly. The most obvious sign of malpractice is when there is complete transection (i.e., cutting) of the common bile duct. During a lap choly, the goal is to clip and cut the cystic duct and cystic artery, allowing the gallbladder to be safely removed. The common bile duct, however, is to remain intact. At times, though, doctors may fail to visualize and identify the anatomy prior to clipping and cutting, despite the fact that this it is generally accepted in the medical community that the anatomy must be carefully identified before clipping and cutting. When a surgeon fails to identify the anatomy first or improperly identifies the anatomy, the common bile duct may be mistaken for the cystic duct, and the doctor may clip and cut it improperly, causing devastating injury to the patient. Once the common bile duct is clipped and cut, it could be fixed if identified and addressed within a brief period of time, but most often, the injury is not discovered for days, by which time the clipped and closed common bile duct is no longer viable, and alternative procedures are required. In cases where the wrong duct is clipped and cut, the initial surgical report may suggest that everything was done properly; after all, the doctor believed that he was cutting the correct duct and his or her records will reflect that belief. After the operative report is carefully reviewed along with the post-operative care records, we can determine whether the seemingly-standard lap choly was in fact performed in a medically negligent manner due to misidentification of the ducts.
While the examples are instructive, they are not the only ways that malpractice may occur. Commonly, we encounter scenarios where doctors admit to difficulty identifying the anatomy, but proceed with the laparoscopic procedure anyway, resulting in a variety of potential injuries. Difficulty identifying the anatomy may occur for various reasons, including prior surgeries in the abdomen which may have caused internal scar tissue or adhesions or abnormal anatomy of the patient. In circumstances where a doctor has difficulty identifying the anatomy, the doctor may convert the laparoscopic procedure (which involves small incisions through which cameras and tools are inserted to allow removal of the gallbladder without direct visualization) to an open procedure (which involves opening the abdomen surgically so as to directly visualize the anatomy). Alternatively, an intraoperative cholangiogram (an x-ray aided by a dye injected into the biliary system that blocks x-rays) can be performed to assist the doctor in identifying the anatomy. When a surgeon fails to do either of these things, but continues with the lap choly despite difficulty identifying the anatomy, bad results can occur.
Know Your Rights
Generally, a lap choly is a safe procedure, but mistakes and complications do occur, sometimes even without malpractice. Regardless, it is important to know your rights and contacting an attorney like Trief & Olk will start you on your way to determining whether your bad results were a result of medical negligence. If you have suffered after undergoing laparoscopic cholecystectomy and want to learn more about your rights, you can contact Trief & Olk at our website or call us at 212-486-6060.