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 pound m, of which 4.3 pound m 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.