Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.
The external branch of the superior laryngeal nerve (EBSLN) is the only motor supply to the cricothyroid muscle and has an important role during phonation in high frequencies. Iatrogenic injury of the EBSLN, most commonly during thyroid surgery, is associated with varying levels of alterations in phonation, which may have an impact on a patient's life, especially when his or her career depends on the full range of voice. EBSLN injury incidence after thyroid surgery ranges widely in the literature (0 to 58%). Despite this wide variation, it appears that EBSLN injury is a not uncommon, and frequently overlooked, complication of thyroid surgery. An in-depth knowledge of the surgical anatomy of the EBSLN is therefore required from the part of the operating surgeon to protect this nerve during thyroid surgery.
For more than a century, emergency appendectomy has been a 'surgical dogma' in the management of acute appendicitis (AA). During recent decades, however, there is an increasing body of evidence suggesting that selected patients with AA could be treated conservatively. This approach has many advantages, including high success and low recurrence rates, reduced morbidity and mortality, less pain, shorter hospitalization and sick leave, and reduced costs. Despite that conservative management of AA cannot be used for all patients with AA (for example, in the presence of peritonitis), it could be preferred in a large percentage of patients with mild infection (as evidenced by clinical, laboratory, and imaging findings).
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