Bile Duct Injury and Litigation in Laparoscopic Cholecystectomy: A Global Review of Current and Future Preventative Initiatives.

Objective: This narrative review examined factors contributing to the initiation and outcome of litigation of bile duct injury (BDI) in laparoscopic cholecystectomy (LC), with reference to case studies and legal precedents in Australasian and international jurisdictions. It also explored potential strategies to prevent BDI and subsequent malpractice litigation. Background: Despite the advantages of minimally invasive surgery, the reported iatrogenic BDI rate in LC remains higher than that in some open cholecystectomy series. The resulting BDIs are also more complex and severe. BDI is a serious complication, and medicolegal costs are a substantial burden for healthcare and insurance systems. BDI persists as one of the most common reasons for malpractice lawsuits against general surgeons in the United States and United Kingdom. Methods: PubMed, Ovid (Medline), Embase, Google Scholar, and Westlaw databases were searched for studies related to BDI in LC and its litigation. Results: Reasons for initiation of claims after LC include inadequate informed consent and unexpected postoperative course, severe physical disability or death after BDI, belief of medical negligence, and plaintiff loss of income. Identifiable perioperative risk factors for BDI and its litigation should be addressed to minimize BDI, malpractice complaints, and medicolegal costs. Conclusions: The narrative review of international literature suggested that BDI during the performance of LC and its associated litigation remains preventable. Implementation of heuristics training, navigation paradigms, and a universal culture of safety in the performance of LC is required to improve rates of BDI and medicolegal ramifications.