“the entrepreneurial exploration of the procedure is some areas has further complicated the objective analysis of the procedures “
Occurrence of Bile Duct Injury during the early 1990’s learning (experimental ) stage reached epic levels of 15%. This risk was never disclosed to new patients. Surgeons training requirements were priority and patient injury was an acceptable outcome. (this does no reflect well for Doctor medical ethics)
Fast forward today, BDI risk rates are stated as 1:300 to 1:500. .03%. But there are many evidence based medical studies stating risks are as high as 1.4%. ( 7x times higher then disclose rate of risk is a potential law suit of its own)
One secondary care surgeon reported only 27% of BDI were reported by surgeons for secondary care treatment, remaining by GI and other DR. (see below)
A lot of scare damage cause issues are being diagnosed with / as Sphincter of Oddi Dysfunction (Sod) issues. Narrowing from Scare tissues in Bile Ducts.
Risks and Concerns
It would seem this fraud, cholecystectomy with out full disclose of risks during informed consent process is still yet to be fully exposed to the public and patients
Here is some of the reasons for concern:
the biliary system is too delicate and unforgiving for the limitations of laparoscopy–where correct identification of delicate structures relies heavily upon touch/feel, experience, and direct visualization as opposed to the limited view of the range of the camera. They can only see what shows on the monitor. That is not good enough in biliary surgery. Bile ducts are anaerobic tissue in that they have a very limited blood supply: as a result, if damaged, they scar up out of proportion to what the injury requires and this can create a blockage, which causes inflammation, which can cause more blockages, which causes more inflammation…and there is no way to stop it.
Here is another reason:
Using electrocautery, and its known risk of something called “stray current” when using it in a wet environment, they can be cauterizing in one area and literally frying some other structure out of range of the camera.
This is the biggest reason:
in a teaching hospital, as most if not all are, a green trainee is sneaked in after we are anesthetized to perform our surgery and these green trainees make their worst mistakes in the first 20-50 of each procedure they perform. We will never meet the trainee who actually performed our surgery, will have no idea what their experience level is, and worst of all we are cheated of the right and the opportunity to say “no”–it could well be their first–and we do not want to be their first in this kind of surgery, and when the inevitable mistakes are made we are not told, are sent home ignorant of whatever damage has been done, and when we begin manifesting symptoms we are lied to, verbally abused, and given the runaround–the doctors we see are programmed not to actively respond, instead empty our bank accounts running us in circles from one test after another. This training never ends. It is the same today as it was back when this procedure was new.
One study “Impaired Quality of Life 5 Years After Bile Duct Injury During Laparoscopic Cholecystectomy: A Prospective Analysis” exposed the long term risk to health with BDI as being , conclusion: Despite the excellent functional outcome after repair, the occurrence of a BDI has a great impact on the patient’s physical and mental QOL, even at long-term follow-up. One discussion feedback exposes cold truth
Discussion: Prof. A. Johnson: I too found these data fascinating. I think the two key questions are: What were the patients told before they had the operation in the first place? Were they warned about bile duct damage?
and goes of to ask What should we tell patients if they should have the misfortune to have their bile ducts damaged?
More non disclosure concerns:
This is from a patient seeking an explanation post surgery (receiving the cheep BDI repair option carried out on the fly during surgery)
“I was given this article by a doctor at The Cleveland Clinic after I sought care there after I was injured. I didn’t get it (because no one is allowed to intervene/interfere after we are injured) but on the way out the door the doctor asked me to wait, then came back and handed me this article he’d copied from JAMA”
This is from USC Center for Pancreatic and Biliary Diseases
What are the causes of bile duct stricture? –
The most common cause for a benign bile duct stricture is trauma to the bile duct during a laparoscopic cholecystectomy for gallstone disease. It is estimated that approximately 0.1% to 1% of gallbladder operations may lead to injury to the bile duct with subsequent development of a bile duct stricture. In addition to injury to the bile duct, injury to the hepatic artery (the blood vessel that supplies blood to the liver) is commonly associated with a bile duct injury.
How does bile duct injury from laparoscopic cholecystectomy develop?
Patients with bile duct injury after a laparoscopic cholecystectomy can present with the injury soon after the cholecystectomy or many weeks to months after the injury.
Patients who present early usually present with leakage of bile into the abdominal cavity. Some of the symptoms that are associated with this include persistent pain and discomfort and feeling of illness after the laparoscopic cholecystectomy. Patients recover rapidly after laparoscopic cholecystectomy and the majority of patients are back to their pre-surgery state within ten days to two weeks. Patients who continue to complain of symptoms and are not improving should be evaluated for possible bile duct injury from laparoscopic cholecystectomy. Often patients will develop fevers and jaundice.
Patients who develop delayed symtoms from a bile duct stricture usually have scarring of the bile duct from the injury. These patients typically present with dilatation of their bile duct above the point of injury. At the point of injury the scarring gives rise to narrowing so that bile cannot go through. The bile then spills over into their blood and they typically present with jaundice.
Calvete J1, Sabater L, Camps B, Verdú A, Gomez-Portilla A, Martín J, Torrico MA, Flor B, Cassinello N, Lledó S. Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve? https://www.ncbi.nlm.nih.gov/pubmed/10948294
USC Center for Pancreatic and Biliary Diseases BILE DUCT STRICTURES.
Moossa AR, Mayer AD, Stabile B. Iatrogenic Injury to the Bile DuctWho, How, Where?. Arch Surg. 1990;125(8):1028–1031. doi:10.1001/archsurg.1990.01410200092014 https://jamanetwork.com/journals/jamasurgery/article-abstract/594803
Boerma, Djemila et al. “Impaired Quality of Life 5 Years After Bile Duct Injury During Laparoscopic Cholecystectomy: A Prospective Analysis.” Annals of Surgery 234.6 (2001): 750–757. Print. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422134/