Laparoscopic Cholecystectomy Injuries
The Archives of Surgery has a new article that discusses the rate and type of errors that occur during laparoscopic cholecystectomies particularly injuries to the extrahepatic biliary tree. The rate of injury to the extrahepatic biliary tree is twice as high in LC cases as it is in open procedures.
The article reports the results of 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. " The authors report that "[i]n 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."
The authors conclude that "[d]espite 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. "