Malpractice Litigation Involving Laparoscopic Cholecystectomy

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Malpractice Litigation Involving Laparoscopic Cholecystectomy

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ABSTRACTS OF Archives of Surgery: Cost, Cause, and Consequences

Objective: To analyze 44 cases of malpractice litigation involving

laparoscopic cholecystectomy for cost, cause, and consequences of civil

court actions.

Design: Survey of national jury verdict reporting services, covering 20

states jury verdict reporting services, covering 20 states during the

39-month interval from January 1, 1993, to April 30, 1996. The 44

laparoscopic cholecystectomies were performed during the 40-month interval

from February 1, 1989, to June 30, 1992.

Main Outcome Measures: Types of injuries leading to litigation, morbidity

and mortality form injuries, trial verdicts, and cost of liability payments.

Results: The 44 injuries composed 4 main categories of injuries: (1) bite

duct, n = 27, 61%; (2) bowel, n = 7, 16%; (3) major vascular, n = 4, 9%;

and (4) other, n = 6, 14%. Bowel injuries involved trocar or cautery

injury; vascular injuries all involved trocars. There were 7 deaths (16%)

overall from either septic peritonitis resulting from bowel injury (4

patients [57%]) or bile peritonitis involving spills or cystic duct leaks

(3 patients [43%]). no deaths resulted from injury to main bile ducts. Of

the 44 cases, 21 (48%) settled out of court (mean payment, $469 711). Of

the remaining 23 cases proceeding to trial, 19 (83%) were defended

successfully while 4 (17%) concluded with plaintiff jury verdicts (mean

payment, $188 772).

Conclusions: Frequent settlements of cases involving laparoscopic

cholecystectomy injuries that are litigated have resulted in a selection of

cases for increased defensibility at trial. The high mortality rate from

bowel injuries is a new medicolegal finding in laparoscopic

cholecystectomies, as expensive to settle (mean payment, $438 000) as

laparoscopic cholecystectomy bile duct injury (mean payment, $507 000).