Approach of forensic medicine to gossypiboma
M. Arif Karakaya1, Okay Koç2, Feza Ekiz3, A. Feran Ağaçhan4
1Department of Forensic Medicine Instution, İstanbul, Turkey
2Clinic of Gastroentorology Surgery, Ministry Health Training and Research Hospital, Diyarbakır, Turkey
3Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
4Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
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.
Material and 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, radioopaque 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 accident 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. Radioopaque sponge and fluoroscopy were available in 9 (23%) centers in these cases.
Conclusion: 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.
Keywords: Gossypiboma, forensic medicine, complication, surgery
Ethics committee approval was received for this study from the ethics committee of İstanbul Forensic Medicine Institute.
No informed consent was required for this retrospective study.
Externally peer-reviewed.
Concept - M.A.K., A.F.A.; Design - M.A.K.; Supervision - A.F.A.; Funding - M.A.K., O.K.; Materials - M.A.K.; Data Collection and/or Processing - M.A.K.; Analysis and/or Interpretation - A.F.A., F.E.; Literature Review - O.K.; Writer - O.K., A.F.A.; Critical Review - M.A.K., A.F.A.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.