Bile leak after GB removed

[roverdear]

My GB was removed 02/15/13 , no stones GB working @ 30%, using the Da Vinci robot. On 02/17 ER with pain that felt like the start of heartburn, but went around abdom to my back. Told it was gas pain from surgery & sent home. I've had 3 C-Sections & didn't think that was it.
02/16 EMA took me to ER with severe pain & shortness of breath. Received 3 morph shots in probably 30 min & it didn't ease any pain. The pain attacks were very sporadic in how often it happened & how long. I was transported twice to a larger hospital where my surgeon was located. Discharged after 2 days again this time for gas & constipation. I don't know how many CT or HIDA scans I had, but was told nothing showed. I think something was said about my liver enzy being high. I continued having the pain, breathing worse, high BP, & needed husband to move me.
Finally, on 02/22 a CT showed fluid in my abdom. A stint was done that night by a different surgeon. The 23rd I had 2 JP tubes, one in lower left stomach & below chest bone. Discharged the 27th with only the tube @ my chest. Other was just removed on the 19th.
The GB surgeon said there must have been a duct cut that he didn't see, & that he's still not sure of where it was leaking. Why would it take so long for the fluid to show on tests? Why would the leak cause so much pain?

[Christopher R Watters, MD]

It sounds like a difficult situation. The HIDA scan is the standard method to identify a bile leak after cholecystectomy. Although it is very sensitive it is not perfect. What was the sales pitch to use the robot for this straightforward laparoscopic case?

[roverdear]

That it usually has less down time, less scarring, and that he's trying to make it standard for his office. If I had read about it before the surgery, I wouldn't have done it with the robot.

[Christopher R Watters, MD]

As a surgeon, I have not embraced the concept of single incision gallbladder surgery. Generally, the robotic approach is "marketed" as being an improvement on the single incision approach. In other words, one incision is put in the belly button and an inch and a half plug stuffed through the hole. It is beyond me how these patients are then told that they can resume normal activity immediately since they have "only" had laparoscopic surgery. This is a real incision. I have performed over 5000 laparoscopic procedures each with 3 or four small holes and have seen 4 trocar site hernias. I have repaired far more than that in patients having single incision laparoscopic surgery (SILS) by other local surgeons. To a general surgeon, gallbladder surgery is probably the highest liability procedure we do. Why would anyone want to make it more difficult for the minimal change in tiny incisions?