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CHOLECYSTECTOMY AND MEDICAL NEGLIGENCE



Cholecystectomy is a surgical procedure to remove the gallbladder. It is a common surgery, and carries only a small risk of complications. 

Cholecystectomy by laparoscopy approach is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside the abdomen and remove the gallbladder. (commonly performed via four small incisions – 1 for camera and 3 working ports)


In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.


Why it’s done

A cholecystectomy is most commonly performed to treat gallstones and the complications they cause. The surgeon may recommend a cholecystectomy in the following situations:

  • Gallstones in the gallbladder (cholelithiasis)

  • Gallstones in the bile duct (choledocholithiasis)

  • Gallbladder inflammation (cholecystitis)

  • Large gallbladder polyps

  • Pancreas inflammation (pancreatitis) due to gallstone

Cholecystectomy Complications

A cholecystectomy carries a small risk of complications including:

  • Bile leak

  • Bleeding

  • Infection

  • Injury to nearby structures, such as the bile duct, liver and small intestine

  • Risks of general anesthesia, such as blood clots and pneumonia.

Methods to perform cholecystectomy


1. Minimally invasive (laparoscopic) cholecystectomy

During a laparoscopic cholecystectomy, the surgeon makes four small incisions in the abdomen. A tube with a tiny video camera is inserted into the abdomen through one of the incisions. The surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in the abdomen to remove the gallbladder. 

A laparoscopic cholecystectomy isn’t appropriate for everyone. In some cases the surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision and convert to open cholecystectomy because of scar tissue from previous operations or complications or difficulty experienced during the procedure.


2. Traditional (open) cholecystectomy

During an open cholecystectomy, the surgeon makes approximately a 6-inch (15-centimeter) incision in the abdomen below the ribs on the right side. Thereafter the surgeon then removes the gallbladder.


What can construe medical negligence in Cholecystectomy?

The most dreaded complication of laparoscopic cholecystectomy is bile duct injury (injury to the CBD or the common hepatic duct).  

A major risk factor for bile duct injury is relative inexperience on the part of the operating surgeon.  Other risk factors are the presence of aberrant biliary tree anatomy and the presence of local acute or chronic inflammation.

Injuring the bile duct is not always construed as medical negligence. Delay in detection and improper referral and management may be taken as medical negligence. Timely referral to a well experienced and center with appropriate facilities should be done when expertise or equipment is not available. In case there is delay in imaging techniques and delay in diagnosis and the surgeon attempts an unsuccessful repair liability for negligence may arise.

 

Dr. Sunil Khattri sunilkhattri@gmail.com 9811618704


Dr. Anupam Saha 9810627829 anupam56@gmail.com


Dr Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practising Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi

Dr Anupam Saha is a Surgical Gastroenterologist and Liver Transplant Surgeon currently based out of Chandigarh

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