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 that occurred during the procedure. This represents a preventable adverse event that resulted from your actions during surgery rather than from the patient's underlying condition. CBD injury is a recognized complication of laparoscopic cholecystectomy but is considered an error when it occurs due to technical mistakes or misidentification of anatomy, as highlighted in the 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy 1.
This differs from a complication, which would be an adverse outcome arising from the disease process itself or as an expected risk of the procedure despite proper technique. It's also not an apparent error or complication because you are definitively stating that an injury occurred, not suggesting the possibility of one. Proper disclosure of this error is ethically required, demonstrates professional integrity, and is essential for maintaining the patient's trust while allowing them to make informed decisions about their subsequent care. 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, as discussed in the World Journal of Emergency Surgery 1.
The incidence of BDI associated with laparoscopic cholecystectomy is significant, ranging from 0.4-1.5% of cases, and is associated with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life 1. The 2020 WSES guidelines aim to facilitate efficient interdisciplinary cooperation, providing evidence-based recommendations for the prevention, detection, and management of BDIs during cholecystectomy, emphasizing the importance of close cooperation between gastroenterologists, radiologists, and surgeons in the management of BDI 1.
Key aspects of the guidelines include strategies to minimize the risk of BDI during cholecystectomy, BDI rates in general surgery units, classification, staging, and reporting of BDI, management of intraoperatively and postoperatively detected BDI, and indications for antibiotic treatment, clinical, biochemical, and imaging investigations for suspected BDI 1. The guidelines also highlight the importance of providing a specific diagnosis and a precise description of the BDI to expedite the decision-making process and increase the chance of treatment success.
In terms of outcomes, the treatment of BDIs is generally considered successful, with an overall success rate of 83.3% in the early period, although late postoperative complications, such as stricture and cholangitis, can occur, and the incidence of anastomotic strictures varies between 4.1% and 69% 1. The reported incidences of biliary cirrhosis after BDI treatment vary between 2.4% and 10.9%, and mortality rate after BDI is considerable, ranging from 1.8% to 4.6% 1.
Overall, the management of bile duct injuries requires a multidisciplinary approach, and proper disclosure of medical errors is essential for maintaining patient trust and ensuring optimal outcomes. The 2020 WSES guidelines provide evidence-based recommendations for the detection and management of BDIs during cholecystectomy, emphasizing the importance of prompt identification, management, and interdisciplinary cooperation.
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".