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AORN Journal Jul 2019
Review
Topics: Evidence-Based Practice; Foreign Bodies; Humans; Root Cause Analysis; Surgical Sponges
PubMed: 31246305
DOI: 10.1002/aorn.12740 -
Annals of the Royal College of Surgeons... Mar 2013Retained sponges and instruments (RSI) due to surgery are a recognised medical 'never event' and have catastrophic implications for patients, healthcare professionals... (Review)
Review
INTRODUCTION
Retained sponges and instruments (RSI) due to surgery are a recognised medical 'never event' and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies.
METHODS
A comprehensive literature search was performed on MEDLINE(®), Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved.
RESULTS
The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success.
CONCLUSIONS
Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.
Topics: Early Diagnosis; Foreign Bodies; Humans; Incidence; Medical Errors; Needles; Risk Factors; Surgical Instruments; Surgical Sponges
PubMed: 23484986
DOI: 10.1308/003588413X13511609957218 -
Diagnostic and Interventional Radiology... Mar 2010Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which...
Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess.
Topics: Adult; Diffusion Magnetic Resonance Imaging; Female; Foreign Bodies; Humans; Laminectomy; Lumbosacral Region; Magnetic Resonance Imaging; Surgical Sponges; Tomography, X-Ray Computed; Ultrasonography
PubMed: 19813177
DOI: 10.4261/1305-3825.DIR.1183-07.1 -
BMJ Case Reports Jun 2013Gossypiboma, a retained surgical sponge, is a rare complication that can occur after any type of surgery. Despite the precautions, the retention of foreign bodies still...
Gossypiboma, a retained surgical sponge, is a rare complication that can occur after any type of surgery. Despite the precautions, the retention of foreign bodies still occurs. We describe a case of a 33-year-old woman with epigastric pain. She was initially diagnosed with acute cholangitis with choledocholithiasis. Although common bile duct stone was successfully removed endoscopically, her epigastric pain did not completely subside. She had undergone an emergency caesarean section at a suburban maternity hospital 6 weeks prior to the referral. A contrast-enhanced CT revealed an encapsulated mass showing a spongiform pattern with fluids and gas bubbles inside, and gossypiboma was suspected. A retained surgical sponge without radiopaque markers was removed surgically. Except for a wound infection, the postoperative course was uneventful. Gossypiboma should always be considered in the differential diagnosis of indeterminate abdominal pain, infection or a mass in patients with a prior surgical history.
Topics: Abdominal Pain; Female; Foreign Bodies; Humans; Surgical Sponges; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 23813518
DOI: 10.1136/bcr-2013-010059 -
European Radiology Dec 2002Migration of a retained surgical sponge into the bowel is a rare cause of bowel obstruction. Thus far, there have not been any reports that the site of initial migration...
Migration of a retained surgical sponge into the bowel is a rare cause of bowel obstruction. Thus far, there have not been any reports that the site of initial migration of the sponge was identified by imaging studies or surgical exploration because the onset of symptoms is usually delayed. Unique about the case presented herein is that a barium meal follow-through study revealed a duodenal fistula that had developed after uneventful cholecystectomy due to a retained surgical sponge that had migrated into the duodenum and obstructed the distal jejunum. Imaging findings are presented and discussed.
Topics: Duodenal Diseases; Duodenum; Foreign-Body Migration; Humans; Intestinal Fistula; Intestinal Obstruction; Male; Middle Aged; Surgical Sponges; Tomography, X-Ray Computed
PubMed: 12522609
DOI: 10.1007/s00330-002-1408-0 -
The New England Journal of Medicine Sep 2010Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal surgery. The gentamicin-collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.
METHODS
In a phase 3 trial, we randomly assigned 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites to undergo either the insertion of two gentamicin-collagen sponges above the fascia at the time of surgical closure (the sponge group) or no intervention (the control group). All patients received standard care, including prophylactic systemic antibiotics. The primary end point was surgical-site infection occurring within 60 days after surgery, as adjudicated by a clinical-events classification committee that was unaware of the study-group assignments.
RESULTS
The incidence of surgical-site infection was higher in the sponge group (90 of 300 patients [30.0%]) than in the control group (63 of 302 patients [20.9%], P=0.01). Superficial surgical-site infection occurred in 20.3% of patients in the sponge group and 13.6% of patients in the control group (P=0.03), and deep surgical-site infection in 8.3% and 6.0% (P=0.26), respectively. Patients in the sponge group were more likely to visit an emergency room or surgeon's office owing to a wound-related sign or symptom (19.7%, vs. 11.0% in the control group; P=0.004) and to be rehospitalized for surgical-site infection (7.0% vs. 4.3%, P=0.15). The frequency of adverse events did not differ significantly between the two groups.
CONCLUSIONS
Our large, multicenter trial shows that the gentamicin-collagen sponge is not effective at preventing surgical-site infection in patients who undergo colorectal surgery; paradoxically, it appears to result in significantly more surgical-site infections. (Funded by Innocoll Technologies; ClinicalTrials.gov number, NCT00600925.)
Topics: Absorbable Implants; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Colectomy; Collagen; Colorectal Neoplasms; Female; Gentamicins; Humans; Intention to Treat Analysis; Kaplan-Meier Estimate; Male; Middle Aged; Rectum; Surgical Sponges; Surgical Wound Infection; Treatment Failure
PubMed: 20825316
DOI: 10.1056/NEJMoa1000837 -
Advances in Surgery Sep 2017
Review
Topics: Device Removal; Equipment Design; Female; Follow-Up Studies; Foreign Bodies; Humans; Male; Postoperative Complications; Radio Waves; Risk Assessment; Surgical Instruments; Surgical Procedures, Operative; Surgical Sponges; Treatment Outcome
PubMed: 28797342
DOI: 10.1016/j.yasu.2017.03.017 -
The American Journal of Medicine Sep 1963
Topics: Celiac Disease; Diagnosis, Differential; Foreign Bodies; Humans; Iatrogenic Disease; Intestinal Fistula; Peritoneal Cavity; Surgical Equipment; Surgical Sponges
PubMed: 14065883
DOI: 10.1016/0002-9343(63)90185-2 -
AORN Journal Feb 2020
Topics: Humans; Medical Errors; Process Assessment, Health Care; Quality Improvement; Surgical Sponges
PubMed: 31997334
DOI: 10.1002/aorn.12971 -
The Journal of Trauma Nov 2003
Review
Topics: Adult; Colon; Foreign Bodies; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Surgical Sponges
PubMed: 14608181
DOI: 10.1097/01.TA.0000027128.99334.E7