A surgeon has a choice. A diseased gall bladder can be removed through laparoscopic surgery or if there is a problem, or even a potential problem the surgery can be converted from laparoscopic surgery to an open surgery. Robotic removal of the gall bladder is being added to the mix of potential methods for gall bladder removal. Why are there so many errors and so many complications?
In 2015 any complication in gall bladder surgery should be questioned.
The gall bladder is an organ that stores bile. This is a greenish fluid produced in the liver and transported via ducts to the gall bladder where, when needed, the bile is sent via ducts to the small intestine to help in the digestion of fatty foods. Along the way the ducts carrying the bile pass the pancreas and pancreatic digestive enzymes are add to the mix. Stones can form in the gall bladder. These stones can either block the flow of fluid from the gall bladder to the common bile duct or block the flow of fluid in the common bile duct. When that happens there is severe abdominal pain, often radiating to the right shoulder. Diagnosis of the condition is often made with an ultrasound of the abdomen or a CAT Scan of the abdomen.
Errors in removing the gall bladder can lead to destruction of the pancreas, causing diabetes; leakage of bile into the abdomen can lead to biliary peritonitis; perforation of bowel can occur leading to leakage and peritonitis; perforation of major blood vessels leading to immediate death. There are many other potential complications in a procedure which should be routine and error free.
Gall bladder surgery is a very commonly performed surgery. Open gall bladder surgery has been done for decades. This is procedure done by the surgeon making a large incision which provides the surgeon with a great ability to see exactly what has to be done and remove the gall bladder under direct vision. Laparoscopic surgery has mostly replaced open surgery. This procedure is done through the creation of a number of small openings in the belly using a trocar or an instrument to perforate the abdomen. Gas is used to inflate the abdomen then additional instruments enter the abdomen, the gall bladder is localized, the duct is isolated, tied and cut and the gall bladder removed through a small hole. The incisions are small and the recuperation time is rapid.
Errors occur when the surgeon fails to properly identify the anatomical structures. It seems hard to believe but the wrong ducts are tied and cut. The only duct to be tied and cut is the gall bladder duct or cystic duct. If the surgeon does not properly identify this duct, the duct from the liver may be cut, the duct combing the hepatic duct from the liver and cystic duct from the gall bladder going to intestine may be cut, the sutures may not be put on properly leading to leaking and peritonitis with stones possibly left behind.
The liver produces the bile. If a wrong duct is cut or a stone from the common bile duct is not removed, there is a blockage of the free flow of bile after the surgery. The result is pain, a backup of the bile and the patient turns yellow or jaundiced.
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