title: Medical liability in surgery for morbid obesity by adjustable gastric band: nine case reviews.
abstract: Adjustable gastric banding is recognized for its effectiveness in obtaining long-term weight loss with low morbidity-mortality for patients with morbid obesity. However, life-threatening complications can sometimes occur, and surgeons may end up in court. We analyzed complications, some of them lethal, arising from gastric banding surgery in nine patients and the main issues identified by the experts, contributing to the judge's decision. Gastric banding is considered a benign operation, but, of the nine cases examined herein, five resulted in death while the other four had serious consequences with several damages, especially aesthetic and psychological suffering. Perforations of the oesophagus or stomach remain the leading causes of complications; the experts identified several issues from the records that helped the judge to render a decision and condemn seven of the nine surgeons. Three types of faults were considered the responsibility of the doctors: the lack of patient information or incomplete medical records, a clumsy mistake or delay of appropriate treatment due to underestimation of clinical symptoms, and finally, failure to observe the proper indications. Expert opinion focused most often on criticism of postoperative behaviour and failure to make decisions according to the state of the art.
authors.affiliation: Service de médecine légale, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France. Electronic address: lucile.tuchtan@ap-hm.fr.
authors.forename: L
authors.initials: L
authors.lastname: Tuchtan
authors.forename: C
authors.initials: C
authors.lastname: Bartoli
authors.forename: B
authors.initials: B
authors.lastname: Sastre
authors.forename: C
authors.initials: C
authors.lastname: Brunet
authors.forename: G
authors.initials: G
authors.lastname: Léonetti
authors.forename: M D
authors.initials: MD
authors.lastname: Piercecchi-Marti
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D055815:Young Adult
keywords: Expertise; Medical responsibility; Obesity surgery