Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Mar;11(2):130-4.
doi: 10.1111/j.1477-2574.2008.00023.x.

Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy

Pankaj G Roy  1 , Zahir F Soonawalla, Hugh W Grant
Affiliations

Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy

Pankaj G Roy et al. HPB (Oxford). 2009 Mar.

Abstract

Background: 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.

Methods: 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.

Results: 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 6 m pound sterling, of which 4.3 m pound sterling 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.

Conclusions: 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.

Keywords: bile duct injuries; delayed recognition of injury; laparoscopic cholecystectomy; litigations; malpractice claims.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Total number of litigation actions brought for injuries related to laparoscopic cholecystectomy over the 5-year period 2000–2005, showing the relative contribution of biliary injuries, and costs incurred to settle the claims, showing the relative contribution of claims for biliary injuries
Figure 2
Figure 2
Total payments made to settle all claims for injuries occurring during laparoscopic cholecystectomy (LC) and the proportion attributed to bile duct injuries over the 5-year period 2000–2005
Figure 3
Figure 3
Numbers of bile duct injuries recognized at the time of the index operation compared with those recognized later, by year. About 90% of claims for injuries recognized later succeeded, whereas only 50% of claims for injuries recognized during index surgery were successful
See this image and copyright information in PMC

References

    1. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc. 1989;3:131–133. - PubMed
    1. Gadacz TR, Talamini MA, Lillemoe KD, Yeo CJ. Laparoscopic cholecystectomy. Surg Clin North Am. 1990;70:1249–1262. - PubMed
    1. Hugh TB. New strategies to prevent laparoscopic bile duct injury – surgeons can learn from pilots. Surgery. 2002;132:826–835. - PubMed
    1. McLean TR. Risk management observations from litigation involving laparoscopic cholecystectomy. Arch Surg. 2006;141:643–648. discussion 648. - PubMed
    1. Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006;93:158–168. - PubMed

LinkOut - more resources