Botched Laparoscopic Cholecystectomy (Gallbladder Surgery) Resulting in Severed Common Bile Duct
The Lycene Case
This case involves a negligent Cholecystectomy (gallbladder surgery) where the surgeon carelessly cut the common bile duct resulting in a Roux-en-Y hepaticojejunostomy. On behalf of the 42-year old patient, we brought suit against the general surgeon who performed the surgery.
Gallbladder: A pear-shaped organ that sits just below your liver on the upper right side of your abdomen. It stores a substance called bile made by the liver. It keeps the bile until the body needs it to digest fatty foods.
Cholecystectomy: A surgical procedure to remove the gallbladder. It helps people when gallstones cause inflammation, pain or infection. The surgery involves a few small incisions, and most people go home the same day and soon return to normal activities. This is typically the most common type of surgery that a general surgeon performs.
Common Bile Duct: A small, tube-like structure formed where the common hepatic duct and the cystic duct join. Its physiological role is to carry bile from the gallbladder and empty it into the upper part of the small intestine (the duodenum). It should not be cut during gallbladder removal surgery. If a surgeon is not careful, it can be mistaken for the cystic duct which should be cut to remove the gallbladder; however, a surgical technique called the Critical View of Safety should ensure that the wrong duct is not cut.
Critical View of Safety: This is a method used by surgeons to properly identify the cystic duct and cystic artery during laparoscopic cholecystectomy. According to the Society of American Gastrointestinal and Endoscopic Surgeons (“SAGES”), the three criteria are required to achieve the CVS:
- The hepatocystic triangle is cleared of fat and fibrous tissue. The hepatocystic triangle is defined as the triangle formed by the cystic duct, the common hepatic duct, and inferior edge of the liver. The common bile duct and common hepatic duct do not have to be exposed.
- The lower one third of the gallbladder is separated from the liver to expose the cystic plate. The cystic plate is also known as liver bed of the gallbladder and lies in the gallbladder fossa.
- Two and only two structures should be seen entering the gallbladder.
Roux-en-Y hepaticojejunostomy: Hepaticojejunostomy is a procedure to drain bile from the liver into the intestines when normal drainage (common bile duct) has to be& removed or is blocked. The “roux-en-y loop” is the segment of bowel that is actually surgically connected to the bile duct. Prognosis depends on the disease process requiring the procedure. In other words, it is a major operation where the patient’s intestines are drastically rewired.
As discussed above, if surgery is done properly and carefully using the “Critical View of Safety”, a surgeon should not cause damage to an adjacent duct or the liver. Conversely, when a surgeon isn‚t careful, incorrectly clips and cuts the wrong anatomy, then and only then can damage to adjoining ducts and liver occur.
The patient was John Lycene (then a 42-year old married, father of 2 minor children). John was experiencing abdominal pain and was admitted to the local hospital. There, an ultrasound revealed gallbladder „sludge” and John was referred to a local general surgeon. The Defendant Surgeon ordered additional testing and recommended and perform a laparoscopic cholecystectomy.
Following the surgery, while in recovery, John and his wife were told by the Defendant Surgeon that there was some damage to his liver and small intestines, but he also told them that he had repaired the damage, and that it should be of no concern.
In the weeks following the surgery, John became progressively ill. John had abnormal labs and a hepatobiliary iminodiacetic acid (“HIDA”) scan, which revealed a bile leak coming from the liver at the level of the gallbladder fossa. At that point, John was admitted to the Hospital for a bile leak. An Endoscopic retrograde cholangiopancreatography (“ERCP”) was attempted with stenting; however, the procedure was unsuccessful, and John was transferred to tertiary care center in Pittsburgh where he underwent the ERCP with stent placement and was later discharged.
Shortly after returning home from the Hospital, John was seen by the Defendant Surgeon for an incision check due to leakage from his abdomen. A CT scan was ordered which revealed abundant ascites, and another HIDA scan performed showed a persistent bile leak throughout the abdomen. There appeared to be activity draining into the common bile duct and small bile. An ultrasound-guided placement of a pigtail-type catheter into the right lateral subhepatic peritoneum was performed.
John underwent another CT of the abdomen/pelvis that showed a large collection of fluid in the abdomen which was displacing the liver toward its left. The largest portion of the collection was to the right of the right lobe of the liver with the other portion extending to the left anteriorly. An additional tiny adjacent collection anterior to the left lobe of the liver (right of the midline) also seen.
That same day, John was admitted to the local Hospital due to abdominal pain and a syncopal episode. A HIDA scan performed confirmed a continued bile leak and John was transferred back to the tertiary care Hospital in Pittsburgh, where he ultimately had to undergo a Roux-en-Y hepaticojejunostomy, right hepatectomy (liver resection) and abdominal wash-out. There, a large hole was noted in the common bile duct right at the bifurcation.
In summary, as a result of the negligence, John had to be transferred to back to Pittsburgh where he was hospitalized, have his abdomen opened up, and undergo a complex, major reconstructive surgery of the intestinal tract. This resulted in gastrointestinal-related complications for which John continued to treat and had drastically reduced his quality of life. It also left him with significant scarring and decreased appetite. Moreover, John was left with an increased risk for other complications such as bile strictures, additional surgeries, and was even at an increased risk of death.
The Defendant Surgeon denied that he did anything wrong. Notably, when we took his deposition, on cross-examination, he acknowledged that based on his own Operative Report, he never achieved the Critical View of Safety. In fact, the Surgeon testified that his Operative Report describes a negligent performance of the surgery. Incredibly, the Surgeon claimed that he somehow, apparently out of bad luck and coincidence, simply made a mistake when dictating his report and agreed that his Operative Report describes a negligent surgery. He went to claim that it was simply a really bad coincidence that his patient suffered the exact injury that would occur if he performed the surgery exactly the way he described it in his Operative Report. Moreover, the Surgeon could not even describe what exactly he did during the surgery, what anatomy he placed clips on, where he cut, etc.
On behalf of John and his family, we secured an expert surgeon from an Ivy League institution who prepared an expert report detailing the Defendant‘s negligence and the harm caused by it.
Tragically, before he resolution of the case, John died from other causes. We were granted of court to amend the Complaint to reflect a Survival Act Action so that the lawsuit could continue on behalf of John’s Estate.
Shortly before the scheduled jury trial, the case settled for a substantial amount at a private mediation and the proceeds where placed into Court supervised accounts for his minor children.