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

PURPOSE OF THE STUDY: The practice of bariatric surgery has multiplied 3.5 times in France in the last ten years. The purpose of the study is to analyze medico-legal claims in this area in order to identify lessons to improve patient care. PATIENTS AND METHODS: Two visceral surgeons analyzed 358 independent claim files. Age, gender, socio-economic origin, body mass index, surgical history, depression, smoking, anticoagulants, and pre-operative assessment of patients were recorded. The operative indication, the type and date of occurrence of the event, the existence and causes of intra-operative incidents, re-interventions, inter-hospital transfers and deaths were noted. Any anomaly of care, whether noted by the expert or the court, was considered a fault. RESULTS: The types of bariatric procedures included sleeve gastrectomy in 52.1% of cases and gastric bypass in 33.2% of cases. A third of patients (31.2%) had a history of previous abdominal surgery. The main complications were anastomotic leak (48.6%), followed by vomiting, wounds of neighboring organs, and infections. Fault was found in 30.4% of cases: for delay of care (36.8%), surgical clumsiness or ineptitude (15.5%), incorrect indications, lack of patient information. In 6.4% of cases, metabolic deficiencies with encephalopathy developed. CONCLUSION: The indications of the French High Authority of Health [Haute autorité de santé (HAS)] must be respected and intra-operative difficulties should not be underestimated in patients who have undergone previous surgery. Post-operatively, clinical signs of severity take precedence over complementary examinations, even when negative. Close monitoring is necessary to quickly detect complications that occur outside the facility, whether it is a surgical complication or vitamin deficiency.

Hernioscopy: technique and indications.

Hernioscopy is laparoscopy traversing a hernial sac used in the course of traditional treatment for groin hernia and it may be both diagnostic or therapeutic. The technique involves dissecting the hernial sac followed by incision, and the creation of a pouch into which a trocar is passed to permit laparoscopy. Once detected an abdominal lesion can also be treated laparoscopically: adhesiotomy, debridement, biopsy etc. The indications to this technique are: strangulated hernia after reduction of the intestinal loop; contralateral diagnosis of inguinal hernia in infants; hernias accompanied by abdominal pain or subocclusive syndromes. For surgeons who adopt the traditional approach to the treatment of groin hernias this technique represents an unexpected addition to their armoury.

[Effect of a histamine aerosol in 20 subjects with histamine hyperreactivity. Application to a study of the protective properties of pipoxizine]. / Action d'un aérosol d'histamine chez 20 sujets ayant une hyperréactivité histaminique. Application à l'étude de l'effect protecteur de la Pipoxizine.

The authors made a study of the antihistaminic properties of Pipoxizine in 20 subjects with proven histaminic hyperreactivity. The design of the trial consisted in comparing the changes of VC, FEC1, expiratory airway resistance and V50 produced by a histamine aerosol given before and after administration of Pipoxizine. Pipoxizine was given by mouth to 10 patients and intravenously to the other 10 of the group. The statistical analysis of the results demonstrated an antagonist effect of Pipoxizine on the histamine induced bronchoconstriction. The data of this trial are confirmative of the results of other experimenters. It seems therefore reasonable to take into consideration the use of Pipoxizine in the preventive treatment of the paroxystic attacks of the asthmatic disease.