title: Approach of forensic medicine to gossypiboma.
abstract: OBJECTIVE
  The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system.
  
  
  METHODS
  This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radio-opaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated.
  
  
  RESULTS
  All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No unexpected event was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radio-opaque sponge and fluoroscopy were available in 9 (23%) centers in these cases.
  
  
  CONCLUSIONS
  Gossypiboma can be prevented not only with surgeons' care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.
authors.affiliation: Department of Forensic Medicine Instution, İstanbul, Turkey.
authors.forename: M Arif
authors.initials: MA
authors.lastname: Karakaya
authors.affiliation: Clinic of Gastroentorology Surgery, Ministry Health Training and Research Hospital, Diyarbakır, Turkey.
authors.forename: Okay
authors.initials: O
authors.lastname: Koç
authors.affiliation: Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: Feza
authors.initials: F
authors.lastname: Ekiz
authors.affiliation: Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
authors.forename: A Feran
authors.initials: AF
authors.lastname: Ağaçhan
keywords: Gossypiboma; complication; forensic medicine; surgery