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Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy.

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.