Although generally considered safer than open surgery, mistakes can be made during keyhole surgery (laparoscopy) and cuts or burns to the bowels can occur. These injuries can potentially be life-threatening if not detected early and repaired.
The bowels form the lower part of the digestive system and include the oesophagus, stomach, duodenum, small bowel (or small intestine) and the large bowel (colon and rectum). Any of these areas can be damaged during a variety of keyhole procedures such as gall bladder removal (cholecystectomy), appendix removal, bowel surgery (colectomy), hernia repairs, hysterectomies, nephrectomy, adrenalectomy, bariatric (weight loss) surgery and anti-reflux treatment.
How Bowel Perforation Results from Medical Negligence
Laparoscopic or keyhole surgery does come with some risks as the organs are not always as visible compared to an open surgery procedure. Tears, cuts and burns to the bowels can occur. However if the mistake is picked up and the damage repaired during the procedure, this, in most circumstances, is not considered medical negligence.
However, mistakes or omissions which may indicate negligence during a laparoscopy or keyhole procedure could include:
- Lack of Consent: The failure to fully explain the risks of bowel injuries and complications of the procedure to the patient.
- Carrying out keyhole or laparoscopic surgery when open surgery or other treatment would have been more suitable:
Although generally considered lower risk, laparoscopies or keyhole surgery may not be suitable in all situations and there may be greater risk of bowel injuries occurring in some situations:
- Obese patients
- Where previous surgeries have taken place
- Presence of adhesions
- Vertical incision
- Where there is extensive bowel distension which may affect the field of view
- Large abdominal or pelvic mass (eg. larger uterus size)
3. Not taking precautions to reduce the risk of bowel injuries in patients with significant adhesions.
Abdominal adhesions may be caused by:
- Previous abdominal surgery
- Abdominal infections
- Inflammatory conditions
- Abdominal trauma
4. Surgical mistakes which could result in cuts or burns to bowel organs:
Mistakes could be made when:
- Inserting a Veress needle or a trocar and / or using the coagulator or grasping forceps could damage or perforate organs such as the:
- Gall bladder, bile duct
- Duodenum and other parts of the small intestines
- Colon, including the Sigmoid colon
- Bowel injuries during a laparoscopy could require further surgery to repair the cut / burn, a bowel resection and the possibility of a stoma. Additional surgical errors which could occur during keyhole or laparoscopic bowel surgery include:
- The failure to remove all diseased parts of the bowel
- Unnecessarily removing healthy parts of the bowel
- The failure to ensure that the parts of the bowel are connected correctly after the diseased part is removed. This is known as anastomosis.
- Tears or other injuries to the bowels could lead to infections such as peritonitis (an infection of the lining of the abdominal wall) and in serious cases septicaemia and organ failure.
- Excision of peritoneal nodules may result in damage to the mesentery (fold of membrane that attaches the intestine to the abdominal wall and holds it in place). This can result in delayed bowel ischemia (insufficient blood supply to the bowels).
- A haematoma or a hernia may also develop in the area of the surgical incision.
5. Electrothermal (heat) injuries to bowel organs and tissues:
- The use of cauterising equipment may release heat which could damage neighbouring organs and tissues. It is important for a surgeon to check for any such and repair them.
Thermal injury to the bowel could occur:
1) inadvertent touching or grasping of the bowel during the application of current
2) a portion of bowel, unnoticed, may come into contact with the laparoscope trocar sleeve;
3) sparking from the coagulation forceps to the bowel;
4) current passing along the fallopian tube and jumping from the fimbriated end to the bowel.
6. Failing to monitor a patient after the laparoscopy:
Bowel injuries such as a tear or burn will result in symptoms in a patient, and it is important the surgeon and hospital staff monitor the progress of their patients’ recoveries and to be prepared to act immediately at any sign of a serious complication. A delay in diagnosing a perforated organ or other issue is associated with a higher risk of septicaemia, open surgery, multiple operations, stoma formation, prolonged hospital stay, and mortality.
Swelling, pain, fever, and nausea are some signs that an injury may have occurred during the procedure and delay in responding to these could have serious and fatal consequences.
7. Failure to monitor patient for signs of an infection:
As with all surgery there is a risk of infection and a patient must be monitored for signs of an infection eg peritonitis, a bacterial infection in the intestinal cavity.
8. Misdiagnosis risks:
During a laparoscopy a surgeon can still misdiagnose or even miss a bowel condition such as bowel cancer which can result in a delay to treatment and reduce the chances of a full recovery.
The consequences of a bowel injury
Injuries to the bowel during keyhole surgery could result in serious consequences such as:
- The formation of an abscess
- Organ failure
The failure of diagnosing and repairing a bowel injury associated with keyhole surgery is associated with a higher risk of septicemia, the need for open surgery, high risk of multiple operations, stoma formation, prolonged hospital stays, and death.
If keyhole surgery or a laparoscopy has resulted in damage to the bowels a surgeon must repair the damage as soon as possible through:
- Surgical repair of the bowel during the operation.
- Emergency surgery following the procedure
- Performing a colostomy to reroute the bowel. This could be reversed later after the patient has recovered, but in some cases, it is permanent.
Common Keyhole Surgeries or Laparoscopies in Which the Bowel Can Be Injured
Laparoscopic or keyhole surgeries are carried out for a variety of conditions and the bowels can be injured during a procedure.
Some of the most common areas include:
- Appendectomy: to remove a diseased or infected appendix
- Colectomy (bowel resection surgery): a surgical procedure to remove all or part of your colon. It is often carried out to treat conditions such as inflammatory bowel disease (diverticulitis), Crohn’s disease, blockages, cancer.
- Proctosigmoidectomy (Hartmann’s procedure): involves removing diseased and damaged portions of the rectum and sigmoid colon – with closure of the anorectal stump and formation of an end colostomy.
- Polypectomy: The removal of polyps in the colon
- Cholecystectomy or gall bladder removal
- Cancer diagnosis: Laparoscopic diagnoses are possible for liver and pancreatic diseases as well as cancer of the pancreas, liver, stomach, bile duct and gallbladder.
- Stomach surgery: laparoscopic surgical repair of a perforated (ruptured) or bleeding peptic or stomach ulcer and removal of certain stomach tumours are common procedures.
- Anti-Reflux Surgery
- Bariatric or weight loss surgery
- Diagnosis of gynaecological conditions: These include pelvic inflammatory disease (PID), infertility, endometriosis, ectopic pregnancy, and ovarian cysts.
- Diagnosis of gynaecological cancers: These include ovarian, cervical, uterine, fallopian tubes cancers.
- Treatment of gynaecological conditions: These include fibroids (benign tumours in or around the uterus), endometriosis, prolapse, removing a pelvic abscess, treating urinary incontinence, and removing the uterus (hysterectomy).
- Removal of ovarian cysts
- Treatment of ectopic pregnancy: A laparoscopy can remove the ectopic or the fallopian tube.
- Diagnosis of urological conditions: These include diseases of the kidney, bladder, adrenals, lymph glands, prostate, ureters.
- Diagnosis of urological cancers: These include cancer of the bladder, ureters and kidneys.
- Nephrectomy and partial nephrectomy: The complete or partial removal of a kidney due to cancer, infection, or kidney disease.
- Prostatectomy: Removal of the prostate gland to treat prostate cancer.
- Treatment of Renal (kidney) cyst
- Adrenalectomy: Benign tumours and cancers may require removal of the adrenal gland.
- Cystectomy and partial cystectomy: Removal of the bladder, known as a cystectomy, or part of the bladder.
- Lymph node dissection: The removal of the pelvic and retroperitoneal lymph nodes to diagnose and treat cancer such as bladder and testicular cancer.
- Ureterolysis: Ureters may require surgery to free them from surrounding scar-like tissue.
How to Claim Compensation For Bowel Injuries Caused by Mistakes Made During Keyhole Surgery
If you believe that mistakes made during your keyhole surgery which resulted in damage to your oesophagus, stomach, duodenum, small bowel (or small intestine) and the large bowel (colon and rectum) – you could be entitled to claim compensation.
Give us a call to speak with one of our specialists. Devonshires Claims’ medical negligence solicitors have experience in dealing with surgical negligence (including keyhole surgery) as well as other medical negligence claims. They will work with you to achieve the best possible outcome including justice for the harm you suffered, and compensation which adequately reflects the injury, pain, financial losses and the need for further medical treatment and care.
We provide victims of medical negligence with:
- A free no-obligation case evaluation
- A ‘No Win No Fee’ agreement
- Access to our network of medical experts and specialist barristers
- Over 20 years’ experience
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