Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland

INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990–2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.

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Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

BMC Surgery ◽

10.1186/s12893-019-0619-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jerzy Lubikowski ◽

Bernard Piotuch ◽

Anna Stadnik ◽

Marta Przedniczek ◽

Piotr Remiszewski ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Abdominal Surgery ◽

Delayed Diagnosis ◽

Biliary Leak ◽

Bile Duct Injuries ◽

Upper Abdominal Surgery ◽

Different Types ◽

Upper Abdominal ◽

Type Of Injury

Abstract Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.

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Does Concomitant Vascular Injury Have an Impact on the Outcome after Surgical Repair of Iatrogenic Bile Duct Injuries

HPB ◽

10.1016/j.hpb.2020.11.925 ◽

2021 ◽

Vol 23 ◽

pp. S362

Author(s):

S. Mahasupachai ◽

S. Asavakarn ◽

S. Limsrichamrern

Keyword(s):

Bile Duct ◽

Vascular Injury ◽

Surgical Repair ◽

Bile Duct Injuries

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Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730123 ◽

2021 ◽

Vol 07 (01) ◽

pp. 037-043

Author(s):

Vinoth M. ◽

Abhijit Joshi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Surgical Procedures ◽

Surgical Repair ◽

Review Of Literature ◽

Bile Duct Injuries ◽

Iatrogenic Bile Duct Injury

Abstract Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

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Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy

World Journal of Surgery ◽

10.1007/s00268-015-3022-8 ◽

2015 ◽

Vol 39 (7) ◽

pp. 1809-1809 ◽

Cited By ~ 1

Author(s):

Hassan Aziz ◽

Viraj Pandit ◽

Bellal Joseph ◽

Tun Jie ◽

Evan Ong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injuries

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The Prevention of Laparoscopic Bile Duct Injuries: An Analysis of 300 Cases of from a Human Factors and Cognitive Psychology Perspective

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120705101103 ◽

2007 ◽

Vol 51 (11) ◽

pp. 617-620 ◽

Cited By ~ 1

Author(s):

Lygia Stewart ◽

Lawrence W. Way

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Human Factors ◽

Bile Duct Injury ◽

Human Error ◽

Perceptual Illusion ◽

Bile Duct Injuries ◽

Psychology Perspective ◽

Cause Of Error ◽

Key Steps

Application of human factors concepts to high-risk activities has facilitated reduction in human error. With introduction of laparoscopic cholecystectomy, the incidence of bile duct injury increased. Seeking ideas for prevention, we analyzed 300 laparoscopic bile duct injuries within the framework of human error analysis. The primary cause of error (97%) was a visual perceptual illusion. The laparoscopic environment contributed to 75% of injuries, poor visibility 22%. Most injuries involved deliberate major bile duct transection due to misperception of the anatomy. This illusion was so compelling that the surgeon usually did not recognize it. Even when irregular cues were detected, improper rules were employed, eliminating feedback. Since the complication-causing error occurred at few key steps during laparoscopic cholecystectomy; we instituted focused training to heighten vigilance, and have formulated specific rules to decrease the incidence of bile duct injury. In addition, factors in the laparoscopic environment contributing to this illusion are discussed.

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