Common complications of surgical procedures are often described as recognised risks but that doesn’t necessarily mean that the injured patient is not entitled to compensation for the injury. One such surgical complication is bile duct injury after cholecystectomy (gallbladder removal), where negligent surgical technique can result in serious injury and substantial compensation claims. What compensation can be claimed for bile duct injury? Compensation can be recovered for the full consequences of bile duct injury. The consequences for each individual are different and depend on the extent to which repair of the initial injury is successful. Compensation is assessed by the court to reflect the direct financial consequences to the patient (treatment costs, loss of earnings, cost of care, other financial losses and expenses) together with compensation for the extent and duration of injury including physical and psychological damage. Compensation awards range from between around £25,000 to in excess of £1,000,000. What are the long-term consequences of bile duct injury? Bile is caustic. Damage to the bile duct leads to bile entering the abdominal cavity causing damage to the bile duct and surrounding tissues. Damage to the bile duct can lead to strictures (narrowing of the repaired duct) which obstruct the flow of bile and lead to infection and liver damage. The list below is not an exhaustive one, but it gives some idea of the consequences that can follow such an injury: Recurrent hospitalisations to treat abdominal collections; Cholangitis (inflammation of the bile duct); Peritonitis/sepsis; Biliary stricture (narrowing of the bile duct) - caused by scarring; Surgery to repair biliary stricture; Jaundice; Chronic nausea and vomiting; Chronic and severe skin itching; Chronic fatigue; Severe abdominal pain and swelling; Liver damage (in extreme cases requiring liver transplant); Scarring; Psychiatric injury, such as depression and anxiety; Reduced life expectancy. What is the gallbladder? The gallbladder is a small organ located under the liver. Its purpose is to store bile that has been produced by the liver, which it then releases into the small intestine to break down the fat in food, allowing nutrients to be absorbed more easily into the bloodstream. What is the bile duct? The common bile duct carries bile from the liver and the gallbladder to the intestines. What is gallbladder disease and what are gallstones? Gallbladder disease is one of the most common digestive problems, often caused or made worse by the formation of small, hard collections of concentrated bile, known as gallstones. Gallstones are very common and often go undetected, but they can cause pain, swelling, blockages and infection/inflammation. Chronic inflammation can eventually damage the gallbladder, impairing its ability to perform its important role in the body’s digestive system. What is cholecystectomy? For many people who suffer from persistent gallbladder problems, the recommended treatment is surgical removal of the gallbladder. This operation is called cholecystectomy and is one of the most common operations performed in the UK. Cholecystectomy may be performed as an ‘open’ abdominal surgical procedure, requiring an extended recovery period of about two months. However, in most straightforward cases the preferred option is laparoscopic (keyhole) surgery, involving minimal scarring, reduced infection rates and a much shorter recovery time of around one week. The gallbladder is attached to the bile duct by the cystic duct. To remove the gallbladder the cystic duct is clipped and cut, and the gallbladder removed, leaving the bile duct intact and the cystic duct closed. How does bile duct injury occur? The bile duct can be injured by trauma or during surgical procedures on the gallbladder, pancreas or stomach but occurs most often during keyhole gallbladder surgery (laparoscopic cholecystectomy). Bile duct injury is the most common complication of keyhole cholecystectomy. The NHS estimates that the bile duct is damaged during cholecystectomy in around 1 in 500 cases. During this procedure, in which the surgeon’s visibility is limited, the bile duct may be cut, burned, or pinched/clipped by surgical instruments. The surgeon may mistake the bile duct for the cystic duct and attach the clip or cut in the wrong place. If the surgeon is unable to identify the cystic duct to remove the gallbladder, they should request help from a colleague or convert the procedure to open (abdominal incision) surgery so that they can visualise and identify the cystic duct, bile duct and gallbladder with 100% confidence. The surgeon may experience greater difficulty in identifying the anatomical structures correctly if there are any of the following: abnormalities in the patient’s anatomy; adhesions; excessive visceral fat; bleeding; impacted gallstones in the cystic duct or neck of the gallbladder compressing the common bile duct or common hepatic duct – known as Mirizzi’s syndrome. What are the symptoms of bile duct injury and when is it diagnosed? Ideally, bile duct injury should be identified during the surgery which caused it, so that the surgeon can repair it immediately. This may involve converting a keyhole procedure to an open procedure so that an effective repair can take place. If the surgeon does not notice at the time of surgery that the bile duct has been injured, the patient will experience post-operative symptoms, which may include: high temperature (fever); chills; abdominal pain and distension (swelling); nausea and vomiting; jaundice (indicating that bile is not draining properly). Post-operative symptoms or delayed recovery from keyhole cholecystectomy should be taken seriously and investigated further to avoid further infection and serious injury from an undetected and untreated bile duct injury or bile leak. Further tests in the post-operative period or later to establish whether there has been an injury to the bile duct may include: transabdominal ultrasound scans; endoscopic retrograde cholangiopancreatography (ERCP) to test for leaks; percutaneous transhepatic cholangiography in which the bile ducts are x-rayed after being injected with dye; magnetic resonance cholangiopancreatography (MRCP). Can I claim? – Boyes Turner can help Whilst bile duct injury is a recognised risk of laparoscopic cholecystectomy (keyhole gallbladder removal), there are circumstances in which the hospital may be found liable for the operating surgeon’s negligent technique. Successful claims have included cases where the surgeon failed to correctly identify the cystic duct before clipping or cutting and clipped or cut the bile duct instead, and where the bile duct has been caught in a clip which was intended to clip only the cystic duct. Where the patient suffers serious injury as a result of the surgeon’s negligence, the patient is entitled to compensation from the surgeon’s NHS employer. Boyes Turner acts for clients who have experienced significant, long-term, life changing injury as a result of bile duct injury. Having established liability by the hospital, we work closely with our clients and experts to identify the full extent of the injury suffered as a result of the bile duct injury to ensure that our clients receive their full entitlement to compensation. If you have suffered a bile duct injury and you would like to find out more about making a claim, please contact Boyes Turner’s medical negligence experts by email at mednegclaims@boyesturner.com.
