Laparoscopic Cholecystectomy

McGowan, Hood & Felder, LLC has handled numerous actions involving Laparoscopic Cholecystectomies in South Carolina and North Carolina.

While “lap chole’s” are not part of the everyday lexicon, the procedure is very common and is simply the surgical removal of the gallbladder. The procedure can be done either laproscopically, where the surgeon makes several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera, or with an “open procedure” which is major abdominal surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision and requiring at least an overnight stay in the hospital.

One of the more common types of injuries resulting from a lap chole is when the surgeon mistakenly identifies the common bile duct for the cystic duct. In order for a surgeon to remove the diseased gallbladder normally he will clip the cystic duct and simply remove the gallbladder. However, before he can remove this organ he must first properly identify the different structures of the biliary tree. A surgeon will do this by removing connective tissue and other types of scarring around the area know as the Triangle of Calot. When sufficient tissue is removed an actual triangle will appear bound by the liver, cystic duct and the common hepatic duct.

When this triangle appears proper identification of the biliary tree is almost without fail. This dissection, however, usually takes about an hour to perform and some surgeons “think” they have identified the cystic duct but are mistaken. A common mistake occurs when the surgeon clips and transects what they believe to be the cystic duct when in fact they mistakenly clip and transect the common bile duct (aka common hepatic duct). It has been my experience that “short cut” mistakes often happen during procedures that are performed late in the day or after the surgeon has already performed a number of other procedures.

When the common bile duct is transected (cut) it cannot simply be sewn back together. Normally transfer to a skilled organ transplant surgeon is required to perform what is known as an hepaticojejunostomy, which is when the small bowel (jejunum) is cut and then connected to the liver (hepatic).

While the common bile duct is improperly transected in only about .4% of cases, there are almost 500,000 of these procedures performed each year in the United States. This number makes it likely that an attorney will see at least one of these cases during his or her career.
Has there been malpractice?

The issue in these cases is not so much if it was negligence to transect the common bile duct, but rather was the surgeon negligent in not positively identifying the cystic duct before he clipped anything. A surgeon should keep cutting away/dissecting until the Triangle of Calot can be positively identified. Clips are then placed on the cystic duct and it is transected. For a number of reasons mentioned above, surgeons will mistake the common bile duct for the cystic duct and proceed to clip and transect it.

The logic can be quite simple when presented in the proper light. If a surgeon positively identifies the cystic duct (which makes up one of the three sides of the Triangle of Calot) then the surgeon should never mistakenly cut the common bile duct. The common defenses are 1) there were so many physical abnormalities (the biliary tree has more differentiation than any other section of the human body), 2) there was too much scar tissue, 3) there was too much bleeding, etc., that the surgeon could not make a positive identification.

These above defenses can be overcome since a surgeon should always revert from laparoscopic to an open procedure when one of the problems above occurs. An “open procedure” provides a surgeon with a much improved field of vision when complications arise. If the injury to the common bile duct occurred during an open procedure, the case may have a stronger defense possibility.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate Laparoscopic Cholecystectomy cases are constantly updating their education and ability to litigate these types of cases. Robert V. Phillips of McGowan, Hood & Felder has helped to litigate many cases that involve laparoscopic cholecystectomy claims. Robert Phillips is available for consultation by email at rphillips@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on Laparoscopic Cholecystectomy.

Very truly yours,

McGowan, Hood & Felder, LLC Robert V. Phillips, 1539 Healthcare Drive, Rock Hill, SC 29732