title: Risk management observations from litigation involving laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Limited information exists on the outcome of laparoscopic cholecystectomy (LC) litigation.
  
  
  METHODS
  A retrospective review of a public malpractice database was compared with previously published reviews of LC litigation by K. A. Kern, MD, and the Physician Insurers Association of America.
  
  
  METHODS
  Private surgery practice. Selection The database was searched for cases containing the terms laparoscopy, bile, or gall between August 1, 1999, and August 31, 2004. Identified cases were further reviewed to select only the unique cases that concerned elective biliary surgery.
  
  
  METHODS
  Surgical technique, injuries, and incidence of conversion to open procedures.
  
  
  RESULTS
  In Kern's study, injuries triggering litigation involved the bile duct in 61%, bowel in 16%, vascular system in 9%, and miscellaneous events in 14%; in the present study, injuries involved the bile duct in 78%, bowel in 2%, vascular injury in 7%, and miscellaneous injuries in 13%. Missed injuries occurred in 86% in the present study and 83% of the Physician Insurers Association of America cases. Although 15% of cases in the present study were converted to open procedures, in 53% of these cases conversion was performed to repair an injury.
  
  
  CONCLUSIONS
  Despite residency training, injuries triggering litigation after LC remain largely unchanged. The nature of the bile duct injuries suggests that routine intraoperative cholangiography is unlikely to make LC safer. To minimize the risk of litigation after LC, it is recommended that the threshold for conversion to open procedures be lowered.
authors.affiliation: Third Millennium Consultants, LLC, Shawnee, Kansas, USA. tmclean@dnamail.com
authors.forename: Thomas R
authors.initials: TR
authors.lastname: McLean
mesh_terms: D001649:Bile Duct Diseases / Q000453:epidemiology* / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012308:Risk Management; D014481:United States / Q000453:epidemiology