A patient who underwent laparoscopic gallbladder surgery found herself back in the operating theatre just four months later. Imaging revealed a remnant gallbladder containing stones, and a second surgery was performed to remove what had been left behind. On the face of it, the case appeared straightforward: if another surgeon had to complete the operation, surely the first one had failed.

The National Consumer Commission saw it differently.

The patient had initially presented with acute cholecystitis complicated by gallstones. During surgery, however, the operating surgeon encountered a far more challenging situation than pre-operative imaging had suggested. The gallbladder was severely inflamed, filled with pus, and surrounded by friable tissue that had distorted the normal anatomy. Most importantly, the critical area around the cystic duct and common bile duct had become difficult to identify safely.

Faced with this situation, the surgeon abandoned the conventional approach and performed a Fundus First Cholecystectomy.

Instead of forcing a complete dissection through dangerously inflamed tissue, he intentionally left a small remnant of the gallbladder behind. His operative notes clearly recorded the intraoperative findings and explained that proceeding further could have caused injury to the common bile duct, one of the most feared complications of gallbladder surgery.

Months later, persistent abdominal pain led the patient to another hospital, where scans identified the remnant gallbladder with retained stones. A completion laparoscopic cholecystectomy was successfully performed, after which the patient alleged that the first surgery had been negligently carried out.

The Commission examined not only the outcome, but the surgical decision-making that produced it.

Expert laparoscopic surgeons testified that a Fundus First Cholecystectomy is a recognised and accepted technique precisely for situations where inflammation obscures vital anatomy.

Attempting complete removal under such circumstances may expose the patient to catastrophic bile duct injury, prolonged disability, and complex reconstructive surgery. In such cases, deliberately leaving a remnant and planning definitive surgery after inflammation subsides may represent the safer surgical course.

That expert opinion became decisive.

The Commission observed that the complainant had produced no independent expert evidence to challenge this explanation. It also noted that the State Commission had largely inferred negligence simply because a second surgery became necessary, without adequately considering the operative findings or accepted surgical practice.

Setting aside the compensation awarded against the surgeon and hospital, the Commission reiterated that medical negligence cannot be inferred merely because treatment is completed in stages. Surgical judgment is assessed by the reasonableness of the decision taken at the time of surgery, not by hindsight after subsequent events unfold.

The judgment reinforces an important reality of modern surgery: completing every step of an operation is not always the safest option. Sometimes, the most skilful surgical decision is knowing exactly where to stop.

IML Insight

Surgeons are often judged by what they remove. Courts increasingly examine why they chose not to.

"Difficult gallbladder" surgery remains one of the most common settings for bile duct injuries. Contemporary surgical guidelines recognise techniques such as Fundus First Cholecystectomy and other bail-out procedures when inflammation obscures anatomy and safe dissection is no longer possible.

From a medico-legal perspective, meticulous operative notes become as important as operative skill. When a surgeon consciously departs from the standard technique to avoid foreseeable harm, documenting the intraoperative findings, anatomical difficulty, and clinical reasoning may provide the strongest defence if the decision is questioned later.

Source : Order pronounced by National Consumer Disputes Redressal Commission on 29th May, 2026.