Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy

• Published in: HPB (Oxford, England) England), 2009-03, Vol.11 (2), p.130-134
• Main Authors: Roy, Pankaj G., Soonawalla, Zahir F., Grant, Hugh W.
• Format: Article
• Language: English
• Subjects: bile duct injuries; delayed recognition of injury; laparoscopic cholecystectomy; litigations; malpractice claims; Original
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/j.1477-2574.2008.00023.x

When laparoscopic cholecystectomy (LC) is performed successfully, recovery is faster than after open cholecystectomy. However, LC results in higher incidences of biliary, bowel and vascular injury. We performed a retrospective review of LC-related claims reported to the National Health Service Litigation Authority (NHSLA) during 2000–2005. The data were analysed from a medicolegal perspective to assess the effects of type of injury and delay in recognition on litigation costs. A total of 208 claims following laparoscopic procedures in general surgery were reported to NHSLA during 2000–2005, of which 133 (64%) were related to LC. Bile duct injury (BDI) accounted for the majority of claims (72%); bowel injury and ‘others’ accounted for 9% and 19%, respectively. Only 20% of BDIs were recognized during surgery; the majority were missed and diagnosed later. Claims related to LC resulted in payments totalling £6m, of which £4.3m was paid out for BDIs. The average cost was higher for patients who suffered a delay in diagnosis, as was the chance of a successful claim. Bile duct injury incurred during LC remains a serious hazard for patients. The resulting complications have led to litigation that has caused a huge financial drain on the health care system. Delayed recognition appears to correlate with more costly litigation.