Laparoscopic Cholecystectomy Case

Surgical Accidents : Pennsylvania Law

The most productive approach to the evaluation of a potential laparoscopic cholecystectomy case must begin with an assessment of the injury produced. One must make this assessment, of course, to make certain that the injury is of sufficient magnitude to warrant further investigation. Additionally, by assessing the specific nature of the injury, one will gain valuable insight into the merits of the potential claim. One variety of cholecystectomy case that cries out for attention involves a patient who suffers a complete transection of either the common hepatic duct or the common bile duct after the cholecystectomy. Such injuries produce bilious abscesses sometimes accompanied by cutaneous fistulas. After the extraductal collection of bile has been evacuated, an effort is generally made to surgically reanastomose the transected bile duct; a substantial portion of duct is usually missing. Even after repair, no functional reconstruction of the bile duct is possible in many cases. Instead, a limb of bowel is tacked up to the base of the liver and the right and left hepatic ducts or a small portion of the common hepatic duct is permitted to drain directly into the bowel. This surgical procedure, known as Roux-en-y, if uncomplicated, provides an excellent conduit for biliary drainage to the small intestine for the digestion of fats and other bile soluble substances.

Unfortunately, even after repair, a very substantial risk exists that re-stenosis or new stenosis will occur in areas because of infection, biliary stasis or both. Statistically, subsequent stenosis or re-stenosis requiring stenting or dilation heightens the chance for cholangitis (bile duct infection), thereby increasing the risk of ultimate liver failure and need for a liver transplant. Statistics also suggest that such stenosis or re-stenosis increases the likelihood of various other adverse outcomes. One must carefully examine subsequent hospital and physician records to identify those risk factors so that a hepatologist could offer credible and well-substantiated opinions about the magnitude of risks associated with a particular patient's history and course.

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