Laparoscopic Gallbladder Surgery Risks and Complications

Because the organs and ducts involved in this surgery are small and close together, and because the surgeon is working by television camera rather than by direct site and direct contact, there are increased risks associated with laparoscopic gallbladder surgery.

Laparoscopic surgery must be performed expertly, slowly, and carefully, by a well-trained surgeon, or terrible consequences can result. The most frequent injury that occurs during the procedure is the cutting of the common bile or common hepatic duct. Since each person’s anatomy is different, it is essential for the surgeon to be careful in properly identifying the ducts he/she intends to cut.

Despite the dire consequences of this error, it is all too common, due in large part to the very thin and small ducts involved and due to their proximity to each other. However, if the bile duct is mistakenly cut or nicked during the surgery, bile will seep into the abdominal cavity and poison the patient.

The location of the injury to the common bile duct determines in large measure the seriousness of the injury and the probability of successful repair. The “higher” the laceration occurs, the worse the prognosis.
The challenge in performing laparoscopic gallbladder surgery correctly is that the surgeon must be able to properly identify each duct on the television camera, and be absolutely certain that he or she is cutting and clipping the proper one.

The gallbladder is connected to the common bile duct through the cystic duct. Mistakenly cutting, clipping or nicking the common bile duct rather than the cystic duct can lead to dire consequences, as can cutting or nicking other organs and/or improperly attaching the clips.

Performed by a properly trained surgeon, laparoscopic gallbladder surgery is a safe procedure. However, as one of the most commonly performed surgeries in our country, this procedure has become big business, and sometimes unskilled doctors undertake the procedure without proper experience and training, putting their patients at risk and causing serious harm.

Laparoscopic Gallbladder Surgery Complications
Improperly performed laparoscopic gallbladder surgery can lead to bile leakage, infection, bile peritonitis, abscess and even death. In the event of a mistake or nicking of the common bile duct, bile may back up into the bloodstream causing jaundice, or it may leak out into the abdominal cavity. 

Biliary duct injuries caused by surgeons can be devastating — and sometimes fatal — to patients who undergo gallbladder surgery.
In addition, if the common bile duct is damaged during the surgery, subsequent corrective surgery may be needed to correct strictures or narrowing of the duct, and still the patient may suffer permanent pain and/or digestive problems. When bile cannot flow through to the intestines, raised liver enzymes, jaundice and severe pain can 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.

Symptoms
Initially, patients may only notice that they’re not feeling well, but eventually the patient will become jaundiced and the liver will stop functioning

Leakage of bile eventually causes symptoms of pain and breathing difficulties. Because of the serious consequences of a bile leak, which poisons the body and can cause death, any such symptoms following surgery need to be promptly investigated. Discharging a patient with any of these symptoms may be medically negligent.

An even more serious situation may be symptoms that do not show up immediately. Bile peritonitis (bile leaking into the abdominal cavity) and/or infection can lead to organ failure and even death, and must be acted upon immediately when the symptoms first appear. This is a situation where there should be no waiting. Immediate action should be taken.

The biggest risk in laparoscopic gallbladder surgery is having an untrained surgeon. This became such a problem on the national level, that the National Institutes of Health (NIH) convened a conference to discuss the problem. In addition, many papers, articles and studies have also been written about the situation. Read More>