Retained surgical sponges: what the practicing clinician should know |
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Authors: | George H Sakorafas Dimitrios Sampanis Christos Lappas Eva Papantoni Spyros Christodoulou Aikaterini Mastoraki Michael Safioleas |
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Institution: | (1) 4th Department of Surgery, Athens University, Medical School, ATTIKON U. Hospital, Arkadias 19-21, 115 26 Athens, Greece |
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Abstract: | 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. |
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