title: Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy.
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.
authors: Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, UK. pankajgroy@yahoo.co.uk
authors: Pankaj G
authors: PG
authors: Roy
authors: Zahir F
authors: ZF
authors: Soonawalla
authors: Hugh W
authors: HW
authors: Grant