Doctor, Is This My Last Surgery?

Abstract

A young agriculture scientist had a biliary colic and was taken for an elective laparoscopic cholecystectomy. Calot’s triangle was found to be frozen so it was converted to open operation when the common bile duct was found to be transected. Immediate end to end repair was done. She started developing progressively increasing jaundice associated with pruritus. ERCP showed a complete cutoff. MRCP showed biliary stricture Bismuth type II. She was referred to us and was operated. Bismuth type II BBS was found and Roux-en-Y side to side hepatico-jejunostomy was done. On POD 5, she had UGI bleed and her hemoglobin fell to 6.0 g/dl. Emergency UGIE revealed a large clot in D2. Emergency relaparotomy was done. Anterior layer of JJ was opened and intra-operative enteroscopy was done through it. Small bowel, including the Roux loop and distal loops, was full of altered blood. There was no bleeding from the HJ site. No active bleeding site was discernible anywhere. Posterior layer of JJ was reinforced and anterior layer was redone. She remained stable and her hemoglobin improved. She was discharged with normal LFT. “Doctor, is this my last surgery?” she asked, when she came to my office to hand over a very girlie colorful note book in which she had written down her story in her pearly handwriting, as beautiful as she herself. I talked to her about her PhD thesis, her exams, and her future career but purposely evaded answering her question as I could not muster the courage to tell a lie and say a definite “yes.” We, at SGPGIMS, have heard more than 700 stories similar to hers—some more and some less painful than hers—in the last 25 years. Most of these could have been avoided or could have been less devastating if the operating surgeons had paid a little more attention while performing the cholecystectomy to make it safe.