The retrospective documentation of legal cases with bile duct injury that were submitted for consideration to İstanbul Forensic Medicine Institute by the courts between 2008-2012

Abstract

Statistical AnalysisThe rates and distributions in this case series were indicated as percentages and frequencies. RESULTSThe physicians were found to be faulty in all the cases that were examined. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, whereas the Objective: The aim was to evaluate the parameters that were considered by Forensic Medicine in bile duct injury as well as the issues that the physicians were found to be faulty. Material and Methods:The following parameters were investigated in 21 files that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012; expert decisions, patient's age, gender, written patient consent, diagnosis, type of first surgery, surgical complications, timing of complication diagnosis within the scope of complication management, patient's referral timing, troubleshooting procedures and mortality rate.Results: Physicians were found to be faulty in all files. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, late recognition of injury and late transfer of the patient in 20 (95.3%) files. Written consent had not been obtained in any of the files. Thirteen patients were female (61.9%) and 8 (30.1%) were male, with a mean age of 43.3 years. Nineteen patients had cholelithiasis (90.4%), and two patients (9.5%) had a mass in the head of the pancreas. Cholecystectomy was performed laparoscopically in 15 patients (78.9%), and with open surgery in 4 patients (21.1%). The Whipple procedure was performed in two patients. The diagnosis was made during the operation in one patient (4.7%), and in the post-operative period in 20 patients (95.3%). The time to diagnosis after surgery was between 3-6 days. All of the patients had been referred to third level health care facilities. The timing of transfer was 1 day in the patient who was diagnosed during the operation, and ranged between 4-10 days in those who were diagnosed postoperatively. Reasons for late referral were delays related to pending test results in 12 patients, vague signs in 3 patients, and following-up patients with the thought that the biliary fistula will heal by itself in 5 patients. Mortality was not observed in any of the examined files. Conclusion:The issues where physicians were most frequently found to be faulty were failure to obtain written patient consent, late recognition of injury and late transfer of the patient.

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

“…After the titles and abstracts were screened for relevance, 22 remaining articles were further assessed for eligibility, and 8 were excluded. The 14 studies, whose characteristics are reported in Table 1, are included in this scoping review [17,[24][25][26][27][28][29][30][31][32][33][34][35]; the reasons of exclusion of the 8 studies are reported in Figure 1 [36][37][38][39][40][41][42][43]. In the 14 studies, 2406 patients were enrolled.…”

“…However, domain 6 was particularly heterogeneous for the no information reported or different methods used to assess outcomes in different intervention groups. Nine out of fourteen studies were assessed as "moderate" risk of overall bias [5,17,[24][25][26]28,29,32,35], while two were determined to have a "serious" risk [27,31], and three a "critical" risk [30,33,34]. Regarding the bias due to confounding, nine out of fourteen studies were evaluated as having a "moderate" risk [5,17,[24][25][26]28,29,32,35]; differently this risk was higher as "serious" in studies performed through insurance surveys or databases [31,34], or "critical" in single team experiences [30,34] or Justice Court [27].…”

Financial Aspects of Bile Duct Injuries

“…Karakaya et al, in their 2014 study, examined 21 cases assessed by the Institution of Forensic Medicine due to bile duct injury after laparoscopic cholecystectomy from 2008 to 2012, finding that all cases of injury were due to surgical inadequacies in cholecystectomy. While the reason for the inadequacies was regarded as “late recognition of bile duct injury and delayed transfer of the patient” in 20 cases (95.3%), it was “failure to provide necessary professional care and attention” in the remaining 1 case (4.7%) [ 16 ].…”

Medico-legal aspects of bile duct injury

“…[ 10 ] The files of 23 legal cases with BDI that were referred by the Turkish courts to the Istanbul Forensic Medicine Institute for expert opinion were analysed — late recognition of injury and late transfer of patient (to a higher centre) was found in 20 (45%) files. [ 11 ] Immediate non-specialist repair is also an independent predictor for possible litigation. [ 12 ] In Germany, four out of 44 cases where BDI was recognized intraoperatively and immediate repair was performed by a biliary surgeon were not considered as malpractice.…”