Surgeon's Error?

Nurses General Nursing

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Specializes in Orthopedic Surgery.

So I recently had a lap chole and ended up in the hospital with complications. For a while the doc thought it might be a leak from a severed common bile duct that happened during surgery. Turns out it was just a stone left over due to the failed intraoperative cholangiogram. One ERCP later I feel tons better! Thank goodness it was not a leak! Anyway it got me thinking, if my bile duct was cut during surgery would that have been a surgeon's error or just a risk I took with that surgery? I asked some of my nursey friends and they were kind of split in their opinions. Just wondering what you all think! Thanks in advance for all the input!

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Specializes in ER, Trauma.

I'd argue it either way. It would be hard to differentiate error from risk, especially with a laparoscopic procedure, IMHO. My surgical experience is limited, maybe an OR nurse will have a more emphatic answer. The more I think about it, the more I think error is a risk.

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Specializes in Orthopedic Surgery.

Very true... I guess you do pretty much sign your life away on those consents!

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Specializes in PACU, OR.

Sorry, can't offer any opinions on what may be a personal medical/legal issue in your life. Sorry you went through this, gallstones are the pits.... I suppose we should be grateful he didn't nick the aorta... saw that happen with a Lap Nissen once - thank goodness the patient came through ok. Theater staff were pretty fragged though! Fact is, these laparoscopic procedures can be tricky. Picture yourself threading a needle using an artery clamp to hold the needle and a tweezer to hold the thread!

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Specializes in Orthopedic Surgery.
Sorry, can't offer any opinions on what may be a personal medical/legal issue in your life. Sorry you went through this, gallstones are the pits.... I suppose we should be grateful he didn't nick the aorta... saw that happen with a Lap Nissen once - thank goodness the patient came through ok. Theater staff were pretty fragged though! Fact is, these laparoscopic procedures can be tricky. Picture yourself threading a needle using an artery clamp to hold the needle and a tweezer to hold the thread!

I can respect that... Luckily it never came to such an issue! The aorta....eeeeh that would be bad! I have learned a lot from this little medical setback for myself! I hope that I can take back to my unit the little bit of insight I received on the other end. Luckily everything turned out okay in the end. I do appreciate your input!

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Specializes in ER/ICU/STICU.

I think it's just a risk of surgery. All surgery's carry risk, even the risk of death.

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Specializes in Nephrology, Cardiology, ER, ICU.

We hope that you are feeling much better now. Take care.

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I have had many years of experience with cholecystectomy, whipple, liver resection, liver transplant, etc. Bile duct leaks are a relatively common post op complication. My understanding from the surgeons is, ...when working in such a small space, especially with a laproscope, "knicking" a bile duct and subsequent bile leak is a known risk factor. The potential damage from the leak is dependent upon how quickly it is diagnosed. I hope that this is helpful.:nurse:

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I had a stone left over after my gallbladder surgery also. It hurt worse (and I didn't think it was possible at the time) then what lead me into the initial gallbladder surgery. I called my husband home to be with the baby (6 weeks old at the time) so I could die. I wouldn't go to the ER because I couldn't imagine waiting in one of those ER chairs when I was going through something like an exorcism on my bed. He eventually called an ambulance. One ERCP later I was also much better.

Childbirth, gallstones, kidneystones, fistula repair surgeries, oral surgeries... the above instance was the most painful experience of my life and what I base my "10" on.

Anyway, sorry no advice to your original question, but thought I'd share my bile duct stone experience in our ERCP bond.

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Specializes in Med/Surg.

I don't see an error.

I take care of lap chole patients all the time. Here's the thing:

You did not, in fact, have a CBD leak. Even if you had, that's a risk that goes along with the surgery itself.

As far as the cholangiogram goes, whether or not the stone was seen at the time, you would have needed a separate ERCP to remove it. If it were caught in the duct, they would have had to cut to get it, and they don't do that....WAY more risky than retrieving it later via ERCP. I have seen plenty of pts have a lap chole one day, and an ERCP the next. It's really not that big of a deal.

Glad you are feeling better.

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Specializes in Operating Room Nursing.

A bile duct leak is a SERIOUS complication and I'm glad to hear that it was a gallstone.

Here's an interesting article that describes how the majority of CBD injuries (97%) are caused by 'visual perception error' rather than technical error by the surgeon.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/

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