title: Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study.
abstract: BACKGROUND
  Bariatric surgery for severe obesity has become an effective and accepted treatment for sustained weight loss.
  
  
  OBJECTIVE
  The aim of our study was to analyze the complications and issues raised by the experts on which jury or judges' decisions were made for the different types of bariatric surgery.
  
  
  METHODS
  University Hospital, France.
  
  
  METHODS
  We have carried out a retrospective study of 59 expert review dossiers over a period of 15 years (1999-2014) on the different types of bariatric surgery (laparoscopic adjustable gastric band [LAGB], sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], vertical banded gastroplasty [VBG], and gastric plication [GP]).
  
  
  RESULTS
  Of the cases, 81% were women and the average age was 39 years old (range 19 to 68 years). Among the procedures giving rise to the complaints, 40% were for LAGB, 28% for RYGB, and 23% for SG. The most common initial complications were perforations (30%), fistulae (27%), bowel obstruction (14%), vascular injuries (9.5%), and infections (peritonitis, pleurisy, abscesses, and so forth) (8%). Revision surgery was required in 78% of patients, and perioperative complications accounted for 28.5% of dossiers. The experts concluded that fault had occurred in 40% of case. Negligence arising from an error deemed to be an act of negligence was found in 30% of cases, 67% of which were because of delayed diagnosis. Major long-term complications accounted for 8% of dossiers and minor long-term complications for 22%. Forty-seven percent of patients completely recovered.
  
  
  CONCLUSIONS
  Delayed diagnosis was the main error established by the experts. Surgeons should remain vigilant postoperatively after every bariatric surgical procedure.
authors.affiliation: Department of Forensic Pathology APHM, CHU Timone, Marseille, France; Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France. Electronic address: lucile.tuchtan@ap-hm.fr.
authors.forename: Lucile
authors.initials: L
authors.lastname: Tuchtan
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.affiliation: Department of General Surgery, APHM, CHU Timone, Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sastre
authors.affiliation: Department of Bariatric Surgery, Hospital Archet 2, Nice, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Gouillat
authors.affiliation: Department of Forensic Pathology APHM, CHU Timone, Marseille, France; Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France.
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Piercecchi-Marti
authors.affiliation: Department of Forensic Pathology APHM, CHU Timone, Marseille, France; Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bartoli
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D057210:Delayed Diagnosis; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Complications; Expert review; Medical liability