Medico-legal claims in bariatric surgery in France between 2010 and 2015

Timsit, Gérard; Johanet, H

doi:10.1016/j.jviscsurg.2019.04.004

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…Another study revealed higher mean cost of €22,470 63. Interestingly, leaks are the most frequent reason for medico-legal litigation in the bariatric population, and were the legal indication in 68% of gastric sleeve patients filing a claim 64…”

Section: Anastomotic Leaksmentioning

confidence: 99%

“…Prompt diagnosis, classification and treatment of leaks is essential 143,154. Delayed management on the other hand (diagnostic testing, antibiotics, and reintervention) leads to worse outcomes and is the most common reason for culpable fault in medico-legal claims of patients undergoing bariatric surgery 64…”

Section: Overview Of Managementmentioning

confidence: 99%

“…143,154 Delayed management on the other hand (diagnostic testing, antibiotics, and reintervention) leads to worse outcomes and is the most common reason for culpable fault in medico-legal claims of patients undergoing bariatric surgery. 64 Treatment strategy depends on patient's clinical condition and leak classification. It includes 3 mainstays: medical support, drainage of leaked material, and repair of the wall defect.…”

Section: Overview Of Managementmentioning

confidence: 99%

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A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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Background: Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.Objective: To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.Design: A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.Results: Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. Conclusion:Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.

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Section: Anastomotic Leaksmentioning

confidence: 99%

Section: Overview Of Managementmentioning

confidence: 99%

Section: Overview Of Managementmentioning

confidence: 99%

See 1 more Smart Citation

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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“…Over the last decade, there has been a steady decrease in complication rates and perioperative mortality associated with bariatric surgery in the United Kingdom (UK), Europe and the United States of America (USA) [ 5 – 7 ]. For example, the 2020 UK National Bariatric Surgical Register reported a postoperative mortality rate of 0.04% and complication rate of 2.4% for bariatric surgical procedures, equally favourable outcomes were also demonstrated in Europe and the USA [ 8 – 10 ]. However, the increase in frequency of bariatric surgery has been accompanied by an increase in litigation involving patients and practitioners, as well as rising medical insurance premiums both in the UK, Europe and USA [ 8 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Medicolegal Cases in Bariatric Surgery in the United Kingdom

et al. 2023

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Purpose of review To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed. Recent findings There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Summary Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up.

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