The plaintiff’s treatment with Dr. A began on June 2, 2014. At that time, she was evaluated for symptomatic vaginal prolapse for the past 10 months, which was affecting her lifestyle. Her current complaint was voiding 15 to 20 times per day and twice per night. Dr. A’s conclusion was vaginal vault prolapse post-hysterectomy. Options of conservative observation, pessary placement, and surgery were discussed in detail. Potential risks and complications were also discussed. The plaintiff agreed to undergo a minimally invasive sacrocolpopexy.
On July 14, 2014, the plaintiff underwent a Pelvic electromyogram (EMG) and urodynamics, which showed that her bladder capacity was normal with sphincter coordination. There was urethral hypermobility with SUI. The plaintiff returned to Dr. A’s office on August 18, 2014, and Dr. A suggested a laparoscopic vs. robotic sacrocolpoplasty with midurethral sling. The plaintiff had Stage 3 anterior wall vaginal prolapse (AWVP) and Stage 2 apical prolapse and underwent urethrosacral culpoplasty with Ethibond and Vicryl without sacrocolpopexy, anterior repair perineorrhaphy, supracervical hysterectomy, and BSO in May 2013. Comorbidities included hypertension, diabetes mellitus, hypothyroidism, gastroesophageal reflux disease, and atherosclerosis. She was postmenopausal.
Dr. A documented an exhaustive discussion with the plaintiff regarding the potential risks and complications of the proposed surgery, which included, among other things, risk of infection requiring antibiotics and re-hospitalization, and risk of damage to adjacent organs including but not limited to the bladder, bowel, ureters, and nerves. The plaintiff also signed a general surgery consent form acknowledging that Dr. A explained the potential risks of the procedure in a way that the plaintiff could understand.
On September 3, 2014, the plaintiff presented to Defendant Hospital for surgery. The procedure performed was diagnostic laparoscopy with lysis of adhesions, sacrospinous ligament fixation, anterior repair, laparotomy, enterotomy repair x 2 and cystoscopy. Laparoscopic findings included dense adhesions noted between the small bowel and anterior abdominal wall extending from the umbilicus to the bladder. The adhesions penetrated into the fascia consistent with a ventral hernia and involved the rectal muscle. There were also adhesions between the colon and lateral sidewalls and the small bowel and bladder. Lysis of adhesions was performed for 1.5 hours. A questionable (non-circumferential) partial rectal prolapse was encountered. Cystoscopy revealed proper positioning of the mesh without perforation or ureteral obstruction. An Obtryx sling material was used.
According to Dr. A’s operative report after the abdominal cavity was surveyed:
“Dense adhesions were noted along the anterior abdominal wall between the small bowel, the omentum, and the anterior abdominal wall. Careful dissection was performed with the monopolar scissors mostly without heat, to lyse the adhesions for about 1.5 hours. During this dissection, as we uncovered the adhesions, we discovered that the bowel was densely adhered to the anterior abdominal wall fascia and rectus muscles. Also a 3 mm serosal tear was noted in the small bowel. This was tagged with a vicryl and colorectal was consulted. He agreed this needed oversewing and further lysis of adhesions and that this would be best achieved via an open incision. We converted to a midline incision (chosen based on where the adhesions were). The abdomen was insufflated as we made an incision with the knife and carried it down to the underlying layer of fascia to help protect the bowel. At this point we connected the incision with the ventral midline hernia just inferior to the umbilicus and entered the peritoneal cavity. We extended the incision inferiorly taking care to avoid the bowel adhesions. At this point colorectal surgery scrubbed in and in running the bowel an enterotomy was identified with no frank spillage and he primarily repaired that with vicryl and then oversewed the previously identified serosal tear. He also assisted with the remaining lysis of adhesions.
At this point, the decision was made to not proceed with the sacrocolpopexy due to the concern for a contaminated field due to the enterotomy. I stepped out to discuss the operative findings and plan with her husband and decision was made to proceed with native tissue repair.”
A typed operative report by the Colorectal Surgeon noted that he was called intra-operatively to assess the small bowel. He further noted in his operative report that “during lysis of adhesion, an enterotomy was noted.” There was a serosal tear in the proximal ileum as well as a full-thickness enterotomy in the mid ileum, which was 25% circumferential. The serosal tear and the enterotomy were repaired with interrupted 3-0 Vicryl suture. There were no other intraoperative or postoperative complications and the plaintiff was admitted overnight for observation.