Belassene Fremdkörper – aus der Sicht des Chirurgen

Abstract

The number of foreign bodies remaining in the patient after a surgical procedure is presumably higher than mentioned in the literature. According to US insurance statistics, the incidence amounts to 1 in 1,500 surgical procedures. As a basic principle--also from the legal aspect--it is necessary to determine whether a foreign body was left in situ accidentally (i.e. due to a material fault) or if it was simply forgotten. In 70% of cases, fabric items (e.g. swabs etc.) are left behind, while around 30% are metal objects. A particularly high risk is seen in emergency settings, in unexpected changes in the surgical procedure, or for patients with a high body mass index. The outcome for the patient differs depending on the nature of the object left behind and the individual patient's situation. Usually, metal items cause more acute clinical symptoms at an earlier time after the operation. Fabric items tend to induce, in the absence of primary contamination, a chronic progression of symptoms over several years. Reoperation has a high mortality (between 11% and 35%). Precautions in terms of risk management have to be established and need to be strictly respected, especially in high risk settings. Visually or acoustically controlled monitoring before wound-closure are recommended to eliminate "human error" as thoroughly as possible.

Retained sponge after abdominal surgery: experience from a third world country

“…Sponges represent 50 to 65% of retained material after surgery [2, 4, 9]; materials such as clamps and retractors have been described [4, 9]. In our study no metallic instrument or other foreign material was recorded.…”

“…It is clear in most recent publications that the rate described is grossly underestimated [4, 6, 7, 8, 13]; reasons for this are related to the possible medico-legal implications, the fear of litigation which could end up in heavy expenses for compensations [1] and adverse publicity for institutions and surgeons; in fact, it is clear that the responsibility of the surgeon and members of the team in the theater could be called in case of litigation [3]. …”

“…In the vast majority of our patients, the probable causative operation was performed as an emergency; emergency procedures have been clearly identified as a major factor for retained material after surgery [2, 4, 6, 9]. According to Bani-Hani et al, emergency procedures increase the risk of leaving o foreign body behind by nine [6].…”

“…Their occurrence usually implies heavy medico legal problems as they may be presumably considered to be related to sub-standard surgical attention or negligence from the operative team [3]. It is suggested that this condition is grossly underestimated [4, 5, 6, 7, 8]; this could be related to the reluctance to report the incident because of its medico legal implications. The occurrence of Gossipiboma has been associated to some variables such as the emergency of the initial procedure, unexpected change in surgical procedure and patient’s body mass index [9].…”

“…The clinical and radiological presentation of Gossipiboma is often confusing, causing delay in diagnosis and proper management [8, 10, 11, 12]; this could end up in serious morbidity and mortality [4, 8]. The diagnosis and management of this condition could be particularly challenging in an environment where the technical background is limited, especially concerning the possibilities of pre-operative diagnosis using imaging tools.…”