Cholecystectomy is the most common hepatobiliary surgery. Many people think it is a minor operation, and its complications are little known. Among them, iatrogenic bile duct injury It is one of the most serious complications. In mild cases, it increases the suffering of patients, and in severe cases, multiple operations are performed, and even death.
Recently, a reporter from “Legal Daily” sorted out several cases of medical damage liability disputes in recent years, Through explaining the law with cases and popularizing the law with cases, both doctors and patients are guided to reasonably resolve medical damage liability disputes in accordance with the law, and strive to build a harmonious doctor-patient relationship. Among them, a case of disability caused by cholecystectomy has attracted our attention:
The patient in this case, Mr. Chen, had cholecystectomy in a hospital in Chongqing in August 2018. He suffered right hepatic duct injury, complicated by bile leakage, peritonitis, biliary pancreatitis and other serious injuries. In 2020, the court determined that this ordinary gallbladder surgery had already caused Chen to suffer serious consequences of an eighth-grade and a ninth-grade disability.
According to my country’s current disability rating standards, even a relatively low grade nine disability means that the patient “most of the daily activities are limited, the ability to work and study is reduced, Mostly limited in social interaction“. This will undoubtedly cause great harm to the quality of life of patients.
This kind of disability caused by gallbladder removal is not an isolated case.
2021
A patient in Wuhu, Anhui Province underwent laparoscopy under general anesthesia after being hospitalized for gallstones Gallbladder removal surgery. Postoperatively, bile duct injury, obstructive jaundice, and common hepatic duct stenosis occurred, accompanied by local atrophy of the duct wall. Later, it was judged as an eighth-grade disability by judicial appraisal.
2016
A patient in Yunnan, Zhang, received gallbladder surgery due to gallstones complicated by acute cholecystitis After the resection operation, symptoms such as bile duct clamping, bile duct injury, bile flaccidity, and biliary peritonitis appeared. In 2019, he was judged as a seventh-grade disability by judicial appraisal, and part of his labor force was lost.
2012
Luo, a patient in Yilong, Sichuan, underwent laparoscopy for gallstones After the lower cholecystectomy, severe abnormal liver function and severe jaundice occurred three days after the operation. It was identified that the common bile duct was cut off and was rated as a seventh-grade disability.
2009
Chongqing patient Yang received abdominal cavity in a hospital in Chongqing due to gallstones After microscopic cholecystectomy, a variety of discomfort symptoms appeared. The disability grade appraisal opinion issued by the Chongqing Forensic Medical Injury Institute stated that the bile duct was damaged during the cholecystectomy. After more than 10 hospitalizations, the patient still had Hepatic hilar bile duct stenosis, biliary cirrhosis, portal hypertension, splenomegaly, moderate ascites, liver function damage and many other complications were rated as four-level disability.
Originally only to treat common gallstones, the patient had to face physical injuries Cruel doom. This pile of tragedy is really shocking. The cause of these tragedies is what is known as “the eternal pain of the surgeon” – iatrogenic bile duct injury.
According to “Minimally Invasive Gallbladder Surgery” edited by National Gallbladder Protection Expert and Professor Liu Jingshan of Peking University Shougang Hospital ” shows that a large number of cases show that there is a 0.5% common bile duct injury rate in gallbladder surgery. According to a retrospective analysis of 1,500 cholecystectomy patients admitted by the Minimally Invasive Hepatobiliary Surgery Department of Beijing Chuiyangliu Hospital from June 2018 to December 2021, the incidence of bile duct injury was 1.20%.
For individual patients, The risk of encountering iatrogenic bile duct injury does not seem to be high, but once such misfortune occurs, it will bring 100% pain and regret to the patient.
Therefore, iatrogenic bile duct injury is not only called “the eternal pain of the surgeon”, but also the “eternal pain” of the patient. What is even more disturbing is that the possible consequences of cholecystectomy are far from iatrogenic bile duct injury.
The liver secretes bile for 24 hours It goes on endlessly. Bile passes into the gallbladder where it concentrates. When a person eats, the concentrated bile is squeezed out at one time and enters the duodenum through the common bile duct to help digestive enzymes digest food.
After the gallbladder is removed, the bile cannot be stored and concentrated. Discharge into the intestinal tract and participate in digestive function. When the fat content of the food is high, the fat cannot be fully digested, and abdominal pain, bloating, and diarrhea are prone to occur.
From 2014 to 2016, the Biliary Tract Surgery Group of the General Surgery Committee of the Shanghai Medical Association and the surgeon of the Chinese Medical Doctor Association The Biliary Surgeons Committee of the branch organized 15 large general hospitals across the country to carry out a “Clinical Investigation and Research on Post-Cholecystectomy Syndrome”. The results of the study found that among the 880 patients who were finally included in the investigation, 245 patients had major adverse symptoms such as abdominal pain, abdominal distension or diarrhea in varying degrees.
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In addition to abdominal pain, bloating, and diarrhea, the loss of gallbladder function caused by gallbladder removal can also cause indigestion, long-term upper abdominal fullness and discomfort, induce gastritis, gastric ulcer, and cause reflux gastritis And reflux esophagitis and other short-term and long-term adverse reactions and complications.
Compared to the adverse reactions and complications that may be encountered after cholecystectomy, “Choledocholithiasis Incidence rate increased” and “incidence rate of colon cancer significantly increased” is undoubtedly more eye-catching.
Professor Qin Xinglu said that after cholecystectomy, the gallbladder loses its buffering effect on the fluid pressure in the bile duct, resulting in Increased pressure in the common bile duct caused the compensatory dilation of the common bile duct, which slowed down the flow of bile in the common bile duct and caused vortices or eddies to precipitate crystals in the center and form stones in the common bile duct. Some studies have pointed out that the number of patients with choledocholithiasis after cholecystectomy is about twice that of patients without gallbladder removal.
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Studies have shown that more than 90% of patients with primary choledocholithiasis have had their gallbladder removed. Common bile duct stones and intrahepatic bile duct stones are far more harmful than gallbladder stones, which may not only cause severe biliary tract infection, induce acute pancreatitis, but also cause damage to liver function.
Not only that, after the gallbladder is removed, the bile secreted by the liver has no place to store, so the bile will be kept around the clock Bile is decomposed by intestinal bacteria to produce secondary bile acids. High concentrations of secondary bile acids are metabolized to produce carcinogenic substances, which may increase the incidence of colon cancer.
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The harm of gallbladder cutting exists objectively, and the damage is often irreversible, which will have a lifelong impact on the patient. For patients with good gallbladder function, he suggested that minimally invasive treatment should be used to preserve gallbladder stones.
Minimally invasive gallbladder-preserving stone removal surgery can completely avoid the sequelae caused by the above-mentioned gallbladder removal. It focuses on protecting the gallbladder function and realizes the transformation from “short-term treatment” to “long-term health” A major change in the treatment of gallbladder is to protect the “should be protected” gallbladder as a means to protect the stability and balance of the human body’s internal environment, thereby protecting the long-term quality of life of patients. At present, Guiyang Stone Disease Hospital has successfully carried out more than 30,000 cases of three mirrors combined with minimally invasive gallbladder stone removal, which has reached the domestic advanced level.