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April 1997

Malpractice Litigation Involving Laparoscopic Cholecystectomy: Cost, Cause, and Consequences

Author Affiliations

From the Department of Surgery, Hartford Hospital, Hartford, Conn, and University of Connecticut School of Medicine, Farmington.

Arch Surg. 1997;132(4):392-398. doi:10.1001/archsurg.1997.01430280066009

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 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 from injuries, trial verdicts, and cost of liability payments.

Results:  The 44 injuries composed 4 main categories of injuries: (1) bile 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 of 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).Arch Surg. 1997;132:392-398

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