Medicine has made a lot of progress over the last hundred years. One of the areas of improvement has been abdominal surgery. In the bad old days, abdominal surgery meant cutting open the patient’s abdomen. The surgeon could then (hopefully) see what the problem was and address it under direct vision. Today, most abdominal surgeries are done through the use of a laparoscope.
Laparoscopic surgery involves the use of small wands, called trochars, which are inserted into the abdominal cavity. No longer must a patient have a large abdominal scar as a souvenir from surgery. Now only a few, small, puncture wound scars are left.
After the first wand is inserted, a gas, usually carbon dioxide, is pumped into the abdominal cavity to expand it and make it easier for the surgeon to see the area and to maneuver the instruments. This process is called insufflation. After the abdomen has been insufflated, the surgeon introduces other wands which contain a video camera and instruments for cutting and removing tissue. The surgeon observes the interior of the abdominal cavity on a TV screen and operates the instruments to perform the procedure.
Of course, in electing to use a laparoscope instead of cutting the abdomen open, there are some trade offs. The main one is that In laparoscopic surgery, the surgeon no longer observes the operative field under direct vision. Instead a camera is used. Sometimes, things that would be seen in an open procedure may not be visible in a laparoscopic procedure.
Even under the best of circumstances, surgeons performing abdominal surgery are working in tight quarters. There are lots of vital organs and they are packed tightly. Insufflation helps create some space but things are still tight. From time to time, a surgeon may nick the bowel or another organ or vessel with the cutting tool. Surgeons are aware of this risk and make every effort to avoid nicking anything, but it happens, even to the best of surgeons. A nick is not malpractice as a nick can occur even when all due care is taken. The problem arises when the surgeon fails to notice the nick and closes the patient back up.
The worst nick to go unnoticed is the bowel nick as the bowel is the sewage pipe of the abdomen. A bowel nick which is noticed is easily repaired and no harm is usually done. A bowel nick which goes unnoticed, however, permits bowel contents to leak into the abdominal cavity. Bowel contents contain bacteria which thrive in the abdominal cavity. They cause inflammation, known as peritonitis. They invade the bloodstream, which carries them throughout the body, causing sepsis. The bacteria can overwhelm the body’s defenses, causing blood pressure to drop and vital organs to lose their perfusion. The result is septic shock, multi-organ failure, and death. This is usually where I come in.
I have had many cases of nicks during laparoscopic surgery. In each case, the nick went unnoticed at the time of the surgery and often for days afterward. In each case, the patient did not make the expected recovery. There was abdominal pain and fever. The symptoms were usually ascribed to normal, post-operative pain. Finally, the patient became so sick she or he was taken back to the operating room. Sometimes, the patient was saved, but on many occasions the patient died.
For those of you having laparoscopic abdominal surgery, be alert to post-operative complications. If you have a lot of pain, a fever, or are just not getting better, say something and then say something again, if no one seems to be paying attention. You are your own best protection against dying due to missed bowel nick. Don’t let the medical people put you off, if you think you are not getting better. Not getting better is the biggest red flag for a laparoscopic surgery gone wrong. Better safe than sorry.
The post The (Sometimes) Fatal Nick appeared first on Sandweg & Ager PC.