Last week a patient presented with one of the complications of operation for gall bladder stones in my emergency. Fifty five year old female was referred from a private hospital about 100km in the interior following development of jaundice. She was operated about a month and a half back for Cholecystitis with cholelithiasis by Laparoscopic cholecystectomy (small incision marks were present at the umbilicus and the other in right flank) and later converted to open – (the Kocher’s incision). The incision site was quite well healed and the patient herself looked cheerful enough other than a completely jaundiced look and her complains of itching all over body.
Now jaundice due to obstruction following gall bladder operation is one of the known and dreaded complication following cholecystectomy. This usually occurs when the common bile duct the tube carrying bile from liver to the gut is injured or clipped. The operation must have been difficult or the surgeon must have been aware of the possible complication as he opened up and had a look see. Serious complication following surgery for gall stones is relatively low but can be devastating for the patient and for the Surgeon involved. The percentage involved is more or less similar all over the world. Some people prefer immediate repair or management if the complication is found while operating but sometimes the injury may remain undetected or present later in the post operative period.
As for this patient; she was further stabilized and subsequently referred to “Mega Hospital” who routinely deal with such procedures. Bile duct injury can have major effect on quality of life and requires expert management subsequently. There is one thing to be said- As gall bladder operation is ‘bread and butter’ for a general surgeon so is its ‘complications’ for lawyers in medical malpractice.
addendum: There is an interesting post in Running a Hospital regarding factors leading to injuries in Laparoscopic cholecystectomy derived from Annals of Surgery with followup comments.