From the Guidelines
The answer is C. Disclosing error. When you inform a patient post-operatively that you injured the common bile duct (CBD) during a laparoscopic cholecystectomy, you are disclosing a medical error. This represents an unintended injury to a structure that should have been preserved during the procedure. CBD injury is a recognized complication of laparoscopic cholecystectomy, occurring in approximately 0.4-1.5% of cases, but it is considered a preventable adverse event resulting from technical error rather than an inherent risk of the procedure 1.
Disclosure of this error is ethically required and involves acknowledging that the bile duct was inadvertently damaged during the operation, explaining the implications for the patient's recovery, discussing what corrective measures are needed (such as biliary reconstruction), and accepting responsibility for the mistake. This differs from disclosing a complication, which would refer to an inherent risk of the procedure that occurred despite proper technique. Transparent error disclosure is essential for maintaining patient trust and is considered standard of care in modern medical practice.
The management of bile duct injuries is complex and requires prompt identification and management, with a wide spectrum of interventions available, including computed tomography (CT)-guided drainage, endoscopic, and surgical techniques 1. The choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis, with studies showing that the incidence of anastomotic strictures varies between 4.1% and 69% after Roux-en-Y hepaticojejunostomy with biliary-enteric anastomosis performed for major BDIs 1.
Key aspects of managing BDIs include strategies to minimize the risk of BDI during cholecystectomy, classification, staging, and reporting of BDI, management of intraoperatively and postoperatively detected BDI, and indications for antibiotic treatment, clinical, biochemical, and imaging investigations 1. The 2020 WSES guidelines provide evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy, emphasizing the importance of multidisciplinary cooperation between gastroenterologists, radiologists, and surgeons 1.
In terms of outcomes, BDI diagnosis can be made early or late during the postoperative period, with the treatment of BDIs generally considered successful, but with potential late complications such as post-cholecystectomy biliary strictures, recurrent cholangitis, and secondary biliary cirrhosis 1. The overall success rate of BDI treatment is around 83.3%, but with a significant rate of late postoperative complications, highlighting the need for long-term follow-up and management 1.
Overall, disclosing an error when informing a patient post-operatively about a CBD injury during laparoscopic cholecystectomy is essential for maintaining patient trust, ensuring transparency, and providing appropriate management and follow-up care.
From the Research
Definition of Terms
- Lap. Chole: Laparoscopic cholecystectomy, a surgical procedure to remove the gallbladder using a minimally invasive technique.
- CBD: Common bile duct, a tube that carries bile from the liver and gallbladder to the small intestine.
Injury to the CBD During Laparoscopic Cholecystectomy
In the context of laparoscopic cholecystectomy, injury to the CBD is a recognized complication. According to 2, bile leaks after laparoscopic cholecystectomy can be due to various causes, including cystic duct leaks, common bile duct stones, and CBD injuries.
Disclosure of Complications
When a patient is informed post-operatively about an injury to the CBD, it implies that a complication has occurred during the surgery. The correct term for this would be:
- Disclosing a complication, as it refers to the act of informing the patient about an unforeseen event that has occurred during the procedure.
Types of Disclosure
The options provided can be analyzed as follows:
- A. Disclosing an apparent complication: This option is not entirely accurate, as the term "apparent" is not necessary in this context.
- B. Disclosing complication: This is the correct answer, as it directly refers to the act of informing the patient about a complication that has occurred.
- C. Disclosing error: While an error may have occurred, the term "disclosing error" is not the most accurate description of the situation.
- D. Disclosing an apparent error: Similar to option A, this option is not entirely accurate, as the term "apparent" is not necessary, and "error" may not be the most appropriate term in this context.
Key Points
- Injury to the CBD during laparoscopic cholecystectomy is a recognized complication 3, 4, 5, 6.
- Disclosure of complications is an essential aspect of patient care and communication.
- The correct term for informing a patient about an injury to the CBD during laparoscopic cholecystectomy is "disclosing a complication".