Bile leak

A patient claimed her surgeon should have converted to an open procedure to locate and repair a bile duct injury caused during a laparascopic cholescystectomy

The MDU successfully defended a general surgeon who received a claim from a patient following post-operative complications of a laparoscopic cholescystectomy. It was alleged by the patient's solicitors that the operation should have been converted to an open procedure.

The patient was referred with a history of numerous episodes of right upper quadrant pain. Investigations showed thickening of the gall bladder with inflammatory changes. Multiple stones in the gall bladder were also noted. The patient consented to have her gall bladder removed laparoscopically. As part of the consent discussion, she was advised that the operation would be converted to an open procedure if required.

During the operation, the surgeon found that the gall bladder was inflamed. He recorded this and also noted that he had identified the cystic duct, cystic artery and common bile duct, and that the artery and duct were clipped and the gall bladder removed.

The cystic artery was difficult to identify, but two structures were identified that were probably a double cystic artery and these were divided in a similar manner. Post-operatively, there was bile in the drains.

Subsequently, the patient required three ERCP procedures and a laparotomy before the leak could be stopped. Further investigation indicated that the leaking duct was a branch of the posterior sectoral bile duct.

The claimant alleged that damage caused during the original laparoscopic cholescystectomy had led to a post-operative bile leak. It was alleged that the bile duct injury should have been identified during the original procedure and that the surgeon should have converted to an open procedure. It was suggested that an open exploration would have allowed more precise localisation and ligation or re-implantation of the damaged duct, depending on its size, into the bowel. If this had occurred, the claimant alleged, she would have avoided the subsequent post-operative complications and the additional surgery required.

The MDU instructed an independent professor of surgery to review the papers and comment on the allegations made against the member. The expert was supportive of the member's management and commented that it was not uncommon for an accessory duct draining small areas of the liver to be divided during cholescystectomy and that the bile leakage usually dries up within a few days. In this case, the expert noted that the duct appeared to be somewhat larger than normal, but it was probable that this duct would have been divided by many surgeons undertaking laparoscopic cholescystectomy in the same circumstances as this case, and there was no evidence that the member failed in his duty of care.

The claim was rebutted on the member's behalf and the claimant's solicitors subsequently confirmed that they would not be pursuing the matter further.

Lee Lewis
Senior claims handler

This page was correct at publication on 10/01/2014. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.