Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements.

Roberto Cirocchi,Anna Maria Verdelli,Angelo De Sol,Gabriele Anania,Giovanni D Tebala,Ewen A Griffiths,Piergiorgio Fedeli,Augusto Lauro,Stefano Avenia,Massimo Lancia,Gloria Burini,Laura Panata,Salomone Di Saverio

doi:10.3390/jcm10225238

Abstract

Background. To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. Methods. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. Results. The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a “poor” visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. Conclusions. During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.

Highlights

Since its introduction, laparoscopic cholecystectomy has rapidly become the gold standard for the treatment of gallstones, due to the significant improvement in overall morbidity, shorter hospital stay, and prompt return to work
Studies have reported an increase in biliary duct injuries (BDI) up to 0.8% with minimal access surgery, which is much higher than the previously reported rates for open cholecystectomy, which was between 0.2–0.3% [3]
The research question of this scoping review was “which are the injuries during laparoscopic cholecystectomy associated with medicolegal claims and civil action?”

Summary

Introduction

Laparoscopic cholecystectomy has rapidly become the gold standard for the treatment of gallstones, due to the significant improvement in overall morbidity, shorter hospital stay, and prompt return to work. Risk of BDI in pediatric patients is even higher (0.5–2.5%), due to the increasing incidence of gallstones and subsequent laparoscopic cholecystectomy in children, and possibly due to the suboptimal experience of pediatric surgeons with this technique [4]. This procedure has shown a consistent increase of the number of insurance claims. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. The most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident

Methods

Results

Discussion

Conclusion