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

Abstract

Background: Retained abdominal sponge after surgery is a quite rare condition which can have heavy medico-legal consequences; its frequency is generally underestimated. Few reports of these conditions are available in African environment with specific technical and medico-legal background. We present our local experience of retained sponges after abdominal surgery and review current literature. Method: A retrospective analysis of the medical files of 14 consecutive patients with a retained surgical sponge after abdominal and urological surgery. Results: The incidence was 1every 677 abdominal operations; no metallic foreign body described, only sponges; the female sex predominated with 10/14 patients. 85.71% of retained sponge occurred after an emergency procedure and 64.28% were gynecological or obstetrical procedures. Most cases presented as intestinal obstruction, localized persistent pain or abdominal mass and pre-operative diagnosis could be done only in 28.57% of cases. A falsely correct sponge count was reported in 71.42% of cases 92.85% of patients were re-operated and the morbidity was low; no death was reported. None of our cases ended in a medico-legal claim despite proper counseling. Conclusion: The incidence of retained sponge might be significantly higher in an environment with reduced medico-legal threat; most cases of retained sponges are still related to human errors; the incidence will probably be reduced by a greater awareness about the condition.

Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases

“…Eventually, in these cases, some RFB could be prevented by using sponge holding forceps. In addition to the previously mentioned factors, many interviewees reported structural and procedural failures, revealing worrisome workplaces frequented by many Brazilian and third world surgeons 19 .…”

“…We had only 129 cases of needles, surpassed even by 237 surgical clamps, seldom mentioned in the medical literature. The most widespread RFB preventive measure is the instrumental counting, which, in many surgical centers, is not standardized or uses only textiles counting [17][18][19] . Even in the places that follow all recommendations of the Association of Perioperative Registered Nurses (AORN), needles represent the most discrepancies in counting 20 .…”

Gossypiboma Mimicking as Ovarian Tumor­-A Rare Case Report

“…To prevent gossypiboma, sponges are counted by hand before and after surgeries as a protocol all over the world. This method was codified into recommended guidelines in the 1970s by the Association of perioperative Registered Nurses (AORN) [5]. Ideally four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure [5].…”

Intra-abdominal gossypiboma: Still a severe postoperative complication

“…Textilomas, as these can also be referred to, were first described in 1884 by Wilson, an American surgeon who published 30 cases occurring in the U.S.A and Europe and emphasized the severity of the complication [3]. The incidence of gossypibomas (0.1%/laparotomy) may be underestimated due to neglect of notification in surgery reports, considering the possibility of legal implications under the current judicialization of Medicine [4,5].…”