LAMINECTOMY PERFORATES (CUTS) STOMACH: MARYLAND MED. MAL. REVIEW

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[The discussion and information contained herein is not intended to be legal advice nor medical advice.  No attorney-client relationship is established between the reader and the author with this blog]

DEFINITIONS

 

1. LAMINECTOMY  is surgery that creates space by removing the lamina --- the back of the vertebra that covers a person's spinal canal.  Also known as decompression surgery, laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves [http://www.mayoclinic.org/tests-procedures/laminectomy/basics/definition].
2. LAPARAOSCOPY is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs.  Laparoscopy is used to find problems such as cysts, adhesions, fibroids and infection.  Tissue samples can be taken by biopsy through the laparoscopic tube [http://www.webmd.com/digestive-disorders/laparoscopy].
3. PEDICLE is a stub of bone that connects the lamina to the vertebral body to form the vertebral arch in the body [http://www.spine-health.com/glossary/pedicle]
4. GRAHAM PATCH defines a surgery procedure to close an opening in the duodenum caused be a peptic ulcer.  The technique is named after a Canadian doctor who successfully used a flap of skin inside the abdominal cavity (the "omentum") to repair perforated ulcers [http://www.wisegeek.com/what-is-a-graham-patch].
5. K-WIRE (or Kirschner Wire) is a steel wire for skeletal transfixion of fractured bones and for obtaining skeletal traction in fractures [http://medicaldictionary/thefreedictionary.com/k-wire].

Case Overview:

A man underwent a minimally invasive surgery according to the surgeon’s report. He had a laminectomy at L4 with K wires placed into the pedicles bilaterally at L4 and L5. Two days later he developed terrible abdominal pain and a CT scan showed free intraabdominal air. Exploratory laparoscopy was performed and was converted to an open laparotomy. Bubbles were seen coming from a pinpoint microperforation in the anterior body of the stomach. Graham patch repair was performed. The man now has a significant vertical scar on his abdomen and has had health issues and pain since this happened.

Issues:

1) Should perforation at that location have occurred?
2) Is this a risk of the surgery?
3) Any other comments would be helpful to decide if we should or should not go forward with this matter.

www.medquestltd.com, medQuest Expert Opinions:

1). The perforation of the stomach should be a standard of care violation. (A neurosurgeon)

2.) Yes.  This is a common kind of case, namely, an injury anterior to the spine during a lumbar surgery. It can be the aorta, intestine.  These generally have merit from the plaintiff’s standpoint. (A neurosurgeon)

3.) This is a risk of surgery. Actually, people would be surprised how often the k-wire is inadvertently advanced too far. I bet that in most cases, nothing important is punctured and there is no consequence. I know that someone will criticize this by saying that it HAS to be malpractice to allow a surgical instrument to get out of control and lead to an injury; but I cannot in good conscience support a case like that.