Abstract
BackgroundThe term gossypiboma refers to a sponge that has been forgotten in the surgical field. It is the most common retained surgical item, and constitutes a continuing problem for surgical safety. We performed a hospital-based study to examine their incidence, root cause, and outcomes, as an effort toward improving prevention.MethodsThis retrospective study covered 10 years (2006-2015) and included surgically confirmed cases of abdominal gossypibomas occurring after 45,011 abdominal and gynaecological operations in 2 public hospitals in Lome (Togo). Age, diagnosis, initial surgical procedure, evidence of textile count, and data related to the revision procedure were collected for descriptive analysis.ResultsFifteen cases of gossypibomas (11 women and 4 men) were recorded. The mean age of the patients was 27 (range 21-55) years. Initial procedures were gynaecological in 11 patients and 5 cases involved an emergency surgery. Evidence of sponge counting was found in 6cases. Gossypiboma was an incidental finding in 1 patient. The average time to onset of symptoms after the initial procedure was 2 months. The gossypiboma was removed within 7 days to 4 years after the initial procedure. Postoperative complications included enterocutaneous fistula in 2 patients, incisional hernia in 2 patients, and wound sepsis in 1 patient. Death occurred in 2 patients (13.3%).ConclusionsAlthough rare, the incidence of gossypibomas is still unacceptably high and reveals failures regarding patient safety standards. The associated morbidity and mortality are significant, yet can be reduced by an early diagnosis in the immediate postoperative period. A systematic methodical count of sponges is the cornerstone of prevention, and introducing surgical safety protocols, such as the WHO Safe Surgery Saves Lives checklist, can enhance effectiveness. There is a crucial need for safety-focused policies, which may include a never event reporting system, elaboration of prevention strategies, interventions, and evaluation.
Highlights
The term gossypiboma refers to a sponge that has been forgotten in the surgical field [1]
Gossypiboma was an incidental finding in 1 patient during an elective re-operation
Gossypibomas are the most common retained surgical item (RSI) [1, 3]. Their frequency after abdominal surgery has been estimated in previous reports to be between 1/1000 and 1/1500 operations [9, 10]. This must be considered as an underestimation, as many reasons can affect their reporting, including medicolegal concerns [1, 3, 8, 9] Gossypibomas are recognised as a medical never event and may be medicolegally indefensible according to the doctrine, res ipsa loquitur [11]
Summary
The term gossypiboma refers to a sponge that has been forgotten in the surgical field It is the most common retained surgical item, and constitutes a continuing problem for surgical safety. We performed a hospital-based study to examine their incidence, root cause, and outcomes, as an effort toward improving prevention. The term gossypiboma refers to a sponge that has been forgotten in the surgical field [1]. Like most of the items on this list, gossypibomas are preventable, and are obviously considered as unacceptable errors. The aim of the present hospital-based study is to examine, the incidence, root cause, and outcomes of gossypibomas, in an effort to contribute to improving prevention
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