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Published on: April 18, 2012
Retained surgical sponges (gossypiboma)
Kamal E Bani-Hani1, Kamal A Gharaibeh, Rami J Yaghan
1Department of Surgery, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan. banihani60@yahoo.com
Objective:
Retained surgical sponges are seldom reported due to medicolegal implications. Awareness of this problem among surgeons and radiologists is essential to avoid unnecessary morbidity. We present our experience with this entity and review the related literature.
Methods:
The medical records of 11 patients who were diagnosed as having retained surgical sponges from 1990 to 2003 were reviewed.
Results:
The incidence was 1:5,027 inpatient operations. There were four males and seven females with a median age of 45 years. The original operations were gynaecological (n=4), general (n=4), urological (n=2) and laminectomy (n=1). In seven cases, the original operation was performed on an emergency basis. Five patients were obese. A presumed correct sponge count was documented in eight cases. The median time between the original procedure and diagnosis of retained sponges was 12 months. The tentative diagnosis was intestinal obstruction (4 patients), urinary tract infection (1 patient), Crohn's disease (1 patient) and tumour recurrence (1 patient). The correct diagnosis was suggested in the remaining four patients. Surgical removal of the retained sponges was carried out in all cases except one, in which the patient passed the sponge spontaneously through the rectum.
Conclusion:
Retained sponges are more common in obese patients and after emergency surgery. A high degree of suspicion is important for preoperative diagnosis. Despite the use of radio-opaque sponges and thorough sponge counting, this moribund mishap still occurs. Although human errors cannot be completely abolished, continuous medical training and strict adherence to regulations should reduce the incidence to a minimum.
Insights
Retained surgical sponges, though rare, occur more often in obese patients and after emergency procedures. Improved surgical counting and training are crucial to minimize this preventable medical error.
Area of Science:
- Medical research
- Surgical safety
- Radiology
Background:
- Retained surgical sponges are infrequently reported due to medicolegal concerns.
- Surgeons and radiologists must be aware of retained sponges to prevent patient harm.
Purpose of the Study:
- To present the experience with retained surgical sponges.
- To review the existing literature on this surgical complication.
Main Methods:
- A retrospective review of 11 patient medical records diagnosed with retained surgical sponges between 1990 and 2003.
- Analysis of patient demographics, original surgical procedures, time to diagnosis, and outcomes.
Main Results:
- The incidence of retained sponges was 1:5,027 inpatient operations.
- Obesity and emergency surgery were identified as risk factors.
- The median time to diagnosis was 12 months, with initial misdiagnoses including intestinal obstruction and tumor recurrence.
Conclusions:
- Retained surgical sponges remain a risk, particularly in obese patients and after emergency surgeries.
- High clinical suspicion is vital for preoperative diagnosis.
- While radio-opaque sponges and meticulous counting are employed, continuous training and adherence to protocols are essential to reduce incidence.
