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Gallbladder Surgery Best Left to Experts

High death rate from complications drops under skilled hands

TUESDAY, Oct. 21, 2003 (HealthDayNews) -- Gallbladder removal is the most common elective surgery in the United States, and usually it's a straightforward affair.

But patients who suffer damage to the organ's main outflow tube during the procedure face nearly three times the risk of death over the next five to 10 years as those whose operations go smoothly, a new study says.

The findings appear in the Oct. 22/29 issue of the Journal of the American Medical Association.

The study of more than 1.57 million gall surgery patients found that about 55 percent of those whose operations were flawless were still alive nine years later, compared with just 19 percent of those whose tubing had been sliced by the scalpel.

On the other hand, when specialist surgeons relief pitch to repair duct damage, the outlook improves. As a result, the researchers say, patients with duct injury after gallbladder removal should be sent to surgeons and surgical centers that handle many gall duct procedures to correct the problem. In three-quarters of cases, the original surgeon did the cleanup job, too, the study found.

"This is something that to a certain extent is unavoidable but in some cases is medical error," says Dr. Leighton Chan, medical director of the pulmonary rehabilitation program at the University of Washington Medical Center and a member of the study team. "If I were a patient and I had this thing happen to me, and I knew that I'd have a better chance of having it repaired by a specialist, that's what I would do."

Injury to the common bile duct is the most frequent reason patients sue general surgeons for malpractice in this country. Even so, duct damage during surgery is rare. In the latest study, about 7,900 of the 1.57 million patients -- or 0.5 percent -- had the complication. Doctors can repair the injury, but older patients and those with other health problems are much more likely to die as a result of the damage, the study found.

Despite the seriousness of a cut duct, it's not always immediately obvious that the tube has been damaged, Chan says. Symptoms may not become clear for several months, by which time the risk of death is much higher.

Dr. Coleman Smith, a digestive disorders expert with Minnesota Gastroenterology in Minneapolis, says the results are important but not surprising. "If you injure the bile duct you're more likely to get liver complications, infectious complications and need repeat surgery," Smith says. Each of these carries potentially serious risks.

The gallbladder helps the body digest fat by storing, concentrating and secreting fat-dissolving bile produced in the liver. For reasons that aren't entirely clear -- but may reflect eating too much fat and carbohydrates -- the gallbladder is prone to the formation of hard stones that can clog its ducts and block bile secretion. An estimated 10 percent to 15 percent of American adults, or 20 million people, suffer from gallstones, according to the National Institutes of Health.

If gallstones don't cause inflammation or infection, they're often left alone. But for many people surgery is the best option, and 750,000 Americans have their gallbladder removed each year.

Doctors used to remove gallbladders by cutting into a patient's abdomen. Now, the procedure is usually performed by laparscopy, using small instruments, tiny incisions, and video equipment to guide surgeons. This less invasive operation is less painful to patients and cuts the average hospital stay compared with the traditional surgery.

The study found no difference in death rates among patients who underwent the two different forms of surgery, Chan says.

More information

For more on the gallbladder and its potential problems, visit the University of Pennsylvania or the American Gastroenterological Association.

SOURCES: Leighton Chan, M.D., M.P.H., medical director, pulmonary rehabilitation program, University of Washington Medical Center, Seattle; Coleman Smith, M.D., Minnesota Gastroenterology, Minneapolis; Oct. 22/29, 2003, Journal of the American Medical Association
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