Cholecystectomy injuries, particularly bile duct injuries, represent the most serious complication of gallbladder surgery. The primary cause of this type of injury is misidentification of anatomical structures during the procedure. This injury is more likely during laparoscopic cholecystectomy, where the surgeon relies on a two-dimensional video image rather than direct visualization during surgery. Critical factors contributing to misidentification include atypical anatomy, inflammation that obscures normal tissue planes, adhesions from previous surgeries, and inadequate exposure of Calot’s triangle—the critical anatomical area that contains the cystic duct and artery. When surgeons mistake the common bile duct for the cystic duct or artery, or when they get lost and cut biliary structures too close to the liver, life-altering bile duct injuries can occur. Over the years, Poulos & Coates has represented dozens of such injured patients and their families.
Technical errors and deviations from established safety protocols significantly increase injury risk. The “critical view of safety” technique, which requires clear identification of two structures (the cystic duct and cystic artery) entering the gallbladder with no other structures seen in the operative field, has been acknowledged to prevent these injuries. However, when surgeons skip this crucial step due to time pressure, overconfidence, or difficult operative conditions, the risk of injury escalates. Similarly, liberal use of clips and/or electrocautery near ductal structures can cause injuries that may not become apparent until sometime after surgery, when bile duct strictures develop.
Patient-related factors and systemic issues also contribute to cholecystectomy injuries. Acute cholecystitis with severe inflammation, previous upper abdominal surgery, and anatomical variants such as atypical bile duct location, all increase technical difficulty and injury risk. Inadequate surgeon experience, particularly in handling complex cases, plays a role, as does fatigue and rushing during emergency procedures. The conversion rate from laparoscopic to “open” surgery has decreased over time as surgeons have become more comfortable with laparoscopic techniques, but this may paradoxically increase injury rates when surgeons persist with the minimally invasive approach in cases where conversion to “open” would be safer. Healthcare system factors including insufficient training, overconfidence with use of laparoscopy, and pressure to maintain operative efficiency can create conditions where safety measures are compromised. Such conditions can lead to severe and sometimes permanent biliary tract injuries.
Ready to understand your legal options for pursuing a malpractice claim for a cholecystectomy bile duct injury? Get clear answers in working with a trusted lawyer. Contact us online or call us at 575-523-4444 to schedule your free consultation.