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Injury to the Common Bile Duct during Cholecystectomy

How an Injury to the Common Bile Duct might occur during Laparoscopic Cholecystectomy

There are situations where an injury to the common bile duct can occur during a laparoscopic cholecystectomy.

Laparoscopic Gallbladder Removal Surgery

During laparoscopic gallbladder removal surgery, there can be times when the surgeon mistakes the common bile duct for the cystic duct.  If the surgeon does not recognize this error before clipping or dissecting, this may produce a serious injury or inappropriate damage or insult to the common bile duct.    

As can be seen in the illustration the cystic duct branches off from the common bile duct.  The identity of these structures can sometimes be difficult to ascertain laparoscopically.  

It is the surgeon’s duty to correctly identify these structures, or, if there is any doubt, to convert the procedure to an open procedure where there can be better visualization of the anatomy and where the surgeon can actually touch and palpate the structures to differentiate the vital structures from the non-vital ones, for the safety of the patient.  

Injury to the common bile duct can produce serious life-long consequences to the patient and must be avoided by the surgeon.     

Injury to the common bile duct may result in bile duct strictures (a narrowing of the duct).  This injury may also cause serious medical consequences including infection, bile leakage, pancreatitis, jaundice, liver damage, and even death.  

Patients are sometimes forced to undergo multiple sent procedures in an attempt to widen the bile duct.  These procedures are not always effective, and the patient may be required to undergo an attempted surgical repair of the common bile duct by a biliary tract surgeon. 

 The attempt to repair an injury to the common bile duct is a challenge for even the most skilled biliary tract surgeon.    

The anatomy of the biliary system will often contain anomalies.  In other words, the structures can become twisted and be located in places where they might not be expect.   

When there is disease associated the structures may be shrunken as well.  There are also many small structures.  

Moreover, some of the structures are merely branches of another.  For example, the cystic artery branches from the hepatic artery proper.  This is a vital artery that supplies oxygenated blood to the gallbladder and cystic duct.  The cystic duct is the short duct that joins the gallbladder to the common bile duct, and usually lies next to the cystic artery.  

During a laparoscopy cholecystectomy these anomalies should be anticipated by the surgeon.  However, it may become confusing to the surgeon, especially where there is a lack of skill and experience, to identify the proper structure since these anatomical features are only being view on a monitor.  

The slightest insult to a vital structure, by even a clip, can cause serious and irreparable injury to the patient.  

It here where the judgment of the surgeon is paramount to avoid these types of injures.  The surgeon should never clip or dissect any structure without being absolutely positive of what structure is being identified. 

When there is even the slightest doubt, the procedure should be converted to an open procedure. 

Medical Malpractice Lawyer

If you or a loved-one sustained an injury to the common bile duct r during a laparoscopic cholecystectomy, you should consult with a New York City medical malpractice attorney to discuss your rights.

DiMartiniLaw.com

1 Comment
  1. I added your blog to bookmarks. And i’ll read your articles more often!

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