Common complications in keyhole surgery result in higher number of claims

However, as MPS claims experience reveals, laparoscopic surgery is not complication-free.  The top four complications resulting in a claim following laparoscopic procedures are:²

1. 47% of claims featured damage to adjacent structures such as the common bile duct, ureters, bladder or uterus.  
2. Perforated bowel (33%).
3. Vascular damage (14%).
4. Failed procedure / problem recurred (4%).

Dr Stephanie Bown, editor-in-chief of Casebook and MPS director of education and communications, said: “There are many advantages to laparoscopic surgery and, for many procedures, this approach has reduced both morbidity and mortality. 

"However, laparoscopy carries unique risks, which the whole healthcare team must be sensitive to if they are to be managed appropriately. Particular care is needed when selecting patients for this form of surgery. 

"Vigilance and awareness of the subtle signs of complications are also essential in the immediate postoperative period. Patients should be told what action to take if signs and symptoms of complications emerge after they have been discharged.” 

Although a complication is not in itself evidence of negligence, reasons for settling claims include: 

• Poor patient selection/preoperative preparation.
• Failure to warn the patient about the complications.
• Poor technique in carrying out the procedure.
• Poor postoperative management.
• Failure to convert to open procedure when necessary.

Casebook includes two case studies which illustrate some of these problems and outlines the key learning points.  

One case involving laparoscopic cholecystectomy examines the frequent complication of damage to the common bile duct which occurs in about 5% of cases. In this case, the patient underwent a surgery which was at the time considered successful.  The following day the patient’s condition deteriorated rapidly.  All attempts to stabilise her situation and take her back to theatre were unsuccessful. She died in the ITU three weeks after surgery. The postmortem examination confirmed that the cause of death was septicaemic shock due to peritonitis as a consequence of the common bile duct being damaged.