West Middlesex University Hospital NHS Trust

3. Mrs O complains about gallbladder surgery she had at the Trust on 29 April 2016. During the surgery, the original plan for laparoscopy (keyhole surgery) was changed to an open cholecystectomy (removal of the gallbladder by a larger incision) as it was difficult to gain access and the surgeons were unable to visualise Mrs O’s gallbladder. Mrs O complains that the surgeon, upon discovering the gallbladder, should have stopped the surgery and referred her to a specialist.

4. Mrs O states her life is ‘on a knife edge’ as her health continues to be affected by how the surgery was performed. She says because of this she is unable to plan for future events.

5. Mrs O would like the Trust to acknowledge the surgeon should have stopped the surgery. She would also like a financial remedy to cover the expenses and disruption to her life caused by three and a half years of ongoing surgery and poor health.

6. Mrs O underwent surgery on 29 April 2016 at the Trust. The procedure was changed to an open cholecystectomy during surgery as it was difficult to gain access and the surgeons were unable to visualise Mrs O’s gallbladder, due to the involvement of hepatic flexure (a bend in the colon) and duodenal (the first part of the small intestine) inflammatory mass.

7. On 16 January 2017 an ultrasound performed by the Trust on Mrs O found fluid collection in the affected area.

8. On 16 August 2017 Mrs O had another operation at the Trust.

9. On 10 June 2018 Mrs O was seen in the clinic at the Trust and noted that the wound had not healed. She was referred to a consultant hepatobiliary (liver and gallbladder) surgeon at Hammersmith Hospital.

10. On 28 January 2019 Mrs O had an appointment with a consultant hepatobiliary surgeon (the specialist) at a different hospital trust. Mrs O says the specialist had suggested that the operation on 29 April 2016 should not have continued.

Change of procedure mid-surgery

14. Section 2.2 of the Cholecystectomy Guidance says the usual treatment option is for the cholecystectomy to be done laparoscopically using several small incisions in the abdomen, although open surgery through a larger incision is sometimes necessary. This is what happened in Mrs O’s case.

15. Our advisor explained from a good surgical practice point of view it is not uncommon for a procedure to start and it not be possible through keyhole to complete the procedure, therefore it would need to be switched to open surgery, as set out in the guidance.

16. Where there would have been a problem is if they had not started a keyhole and had gone straight to an open cholecystectomy, as the guidance says keyhole should be attempted in the first instance. On this case the surgeon started with keyhole and had to convert during the operation.

17. The consent form in the medical records shows that Mrs O was informed that one of the risks of a laparoscopic cholecystectomy is that this can be converted to an open cholecystectomy. Mrs O has confirmed she signed the consent form prior to surgery. The surgeon has noted on the consent form a 20% risk of the surgery requiring conversion to open surgery.

18. The evidence indicates the Trust acted in line with the guidance when it changed Mrs O’s procedure mid operation. We have seen evidence the surgeon gained Mrs O’s consent before the procedure and made Mrs O aware of the risks, including the open cholecystectomy, which was necessary.

19. Mrs O told us when she saw the specialist on 28 January 2019, they indicated a specialist should have been consulted after the surgeon was not able to complete the original procedure. Mrs O was referred to the specialist by the Trust, for his view on her ongoing health problems. This understandably caused her concern, especially when she had had ongoing issues since the surgery in 2016. However, that does not show the surgeon failed in the actions he took.

20. The evidence indicates the surgeon took the action that guidance requires him to take to complete the procedure he started on Mrs O. Mrs O was aware of the risks and had consented prior to the procedure. We recognise it is unfortunate that in Mrs O’s case the open surgery was required and that she continues to suffer problems even now.

21. We consider there to be no indications of maladministration or service failure on the part of West Middlesex University Hospital NHS Trust as the actions taken by the surgeon were in line with the relevant guidance.

1. We have carefully considered Mrs O’s complaint about West Middlesex University Hospital NHS Trust (the Trust) and we have seen no indication that anything went wrong.

2. The evidence indicates the surgeon took the correct action to complete the procedure. Mrs O was aware of the risks and had consented prior to the procedure. We recognise Mrs O has been through a difficult time, with prolonged pain and she has told us she is unable to plan ahead due to numerous required treatments. We appreciate the difficulties she is still experiencing.