LAPAROSCOPIC CHOLECSTECTOMY
General Surgeon from Georgia
This procedure gained worldwide acceptance in the early 1990’s. It essentially replaced open cholecystectomy. Unfortunately, early training in the technique was often inadequate and complications rapidly followed. Entry into the abdomen was Ablind@ with large, pointed trocars resulting in injury to vital organs and large blood vessels. Deaths were recorded with regularity. Internal procedural injuries included injuries or division of bile ducts and destruction of hepatic blood vessels. Both types of injuries can be devastating to the longevity of the patient in spite of adequate, accepted repairs.
The surgeon must be held to the same standards as for open cholecystectomy. Although possible complications may be explained to the patient, deviations from the standard of care include any injury to the bile ducts, major blood vessels or other organs. Inquiries should be made into the training of the surgeon and the number of procedures he or she has performed. Difficulty of the operation does not excuse the damages discussed.
Conversion to an open procedure is paramount when problems arise and adequate and accepted repair procedures must be used. Bile duct injuries often lead to late complications such as liver failure. Multiple operations may be necessary to maintain bile duct patency. Injuries to the hepatic blood supply may lead to necrosis of the liver though this is rare.
Laparoscopic cholecystectomy has been beneficial to most patients, but the same or a greater standard of care used for open cholecystectomy must be forcefully applied.
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