Surgical Sponge Research Articles

Hidden retained surgical sponge with intestinal migration: A rare case report

Introduction and importanceRetained surgical items are mistakenly left items used during surgery. They are not always radiopaque and in literature there are numbers of case reports that were not found by X ray. Transmigration of the retained surgical item to the small intestine is one of the possible outcomes rarely seen in patients.Case presentationwe present a case 32-year-old male with a history of open appendectomy one year ago presented to the emergency department with fever and diffuse abdominal cramps, which worsened after meals.Clinical discussionLab tests, abdominal and pelvis sonography, x-rays and CT scan and small intestine series all were unremarkable and only after defecation of a surgical gauze with blue marker, the diagnosis was made.ConclusionIn all missed items at the end of operation standard counting protocols must be considered and if we couldn't find the missed item never forget the meticulous follow ups because of a great chance of non-opaque item existence, in extremely rare cases the sponge could entered the bowels without obstruction or perforation and eventually defecated.

Chitin-glucan composite sponge hemostat with rapid shape-memory from Pleurotus eryngii for puncture wound

Efficient hemostasis is a great challenge for treating the inaccessible hemorrhage wounds. A novel shape-memory chitin-glucan hemostatic sponge (ATC-Sponge) is constructed via sequentially in-situ removal of protein and glucan from Pleurotus eryngii fruiting body, TEMPO oxidation and Ca2+ crosslinking. The sponge displays interconnected microporous structure with high water absorption and robust mechanical properties. The sponge at dry state shows rapid blood-triggered shape-memory, allowing easy insertion into the puncture wound in a compressed fixed-shape and the subsequent quick volume expansion to conform wound shape to stop bleeding. Compared with standard medical gauze and gelatin sponge, ATC-Sponge demonstrates superior hemostatic performance in the rat femoral artery and non-compressive liver puncture injury models. Additionally, ATC-Sponge can effectively accelerate wound healing. This multi-functional shape-memory ATC-Sponge shows high potential in controlling the bleeding of inaccessible traumas.

Efficacy of Intraventricular Sponge Placement to Capture Debris in Aortic Valve Replacement.

Objective: Surgical aortic valve replacement (SAVR) carries the known risk of shedding debris into the left ventricle during valve leaflet excision and annulus debridement. Embolization of this debris may have devastating effects for the patient. Although surgeons have developed methods to mitigate this risk, no data exist as to their efficacy. Herein, we present the first study that evaluates the efficacy of a technique for capturing debris during SAVR. Methods: Our group conducted a prospective case series of 20 patients who underwent SAVR using the insertion of an intraventricular surgical sponge prior to valve leaflet excision and annulus debridement to capture debris. Surgical sponges were grossly, radiographically, and histologically examined for the presence of cellular and acellular debris to determine the efficacy of this technique. Results: Of the 20 surgical sponges analyzed, 15 specimens (75%) registered positivity for cellular and/or acellular debris. Seven sponges (35%) were grossly positive, 15 sponges (75%) were radiographically positive, and 4 sponges (20%) were histologically positive for calcified debris on examination. Conclusions: This is one of the few studies to objectively evaluate a method used to capture debris in SAVR procedures. Our results demonstrate a high frequency of debris captured within intraventricular surgical sponges and confirms the efficacy of this technique. While these data are promising, numerous additional approaches exist to capture debris, and a best practice standard should exist across the specialty. In addition, this study does not address the clinical outcomes associated with this technique. To these ends, additional data and multicenter collaboration are required.

What a Waste! The Impact of Unused Surgical Supplies in Hand Surgery and How We Can Improve.

The US health care system is the second largest contributor of trash. Approximately 20% to 70% of waste is produced by operating rooms, and very few of this waste is recycled. The purpose of this study is to quantify the opened but unused disposable supplies and generate strategies to reduce disposable waste. A single-center prospective study to evaluate the cost of opened but unused single-use operating room supplies was completed by counting the number of wasted disposable products at the end of hand surgery cases. We used χ2 test, t test, Wilcoxon rank-sum test, and simple linear regression to assess the associations between patient and case variables and the total cost of wasted items. Environmentally Extended Input Output Life Cycle Assessment methods were used to convert the dollar spent to kilograms of carbon dioxide equivalent (CO2-e), a measure of greenhouse gas emissions. Surgical and dressing items that were disposed of and not used during each case were recorded. We included 85 consecutive cases in the analysis from a single surgeon's practice. Higher cost from wasted items was associated with shorter operative time (P = .010). On average, 11.5 items were wasted per case (SD: 3.6 items), with a total of 981 items wasted over the 85 cases in the study period. Surgical sponges and blades were 2 of the most unused items. Wasted items amounted to a total of $2193.5 and 441 kg of CO2-e during the study period. This study highlights the excessive waste of unused disposable products during hand surgery cases and identifies ways of improvement.

Shape-Recoverable Macroporous Nanocomposite Hydrogels Created via Ice Templating Polymerization for Noncompressible Wound Hemorrhage

Uncontrolled hemorrhage resulting from severe trauma or surgical operations remains a challenge. It is highly important to develop functional materials to treat noncompressible wound bleeding. In this work, a shape-recoverable macroporous nanocomposite hydrogel was facilely created through ice templating polymerization. The covalently cross-linked gelatin networks provide a robust framework, while the Laponite nanoclay disperses into the three-dimensional matrix, enabling mechanical reinforcement and hemostatic functions. The resultant macroporous nanocomposite hydrogel possesses an inherent interconnected macroporous structure and rapid deformation recovery. In vitro assessments indicate that the hydrogel displays good cytocompatibility and a low hemolysis ratio. The hydrogel shows a higher coagulation potential and more erythrocyte adhesion compared to the commercial gauze and gelatin sponge. The noncompressible liver hemorrhage models also confirm its promising hemostasis performance. This strategy of combining a nano-enabled solution with ice templating polymerization displays great potential to develop appealing absorbable macroporous biomaterials for rapid hemostasis.

Is the Systematic Sponge Count an Impediment to Patient Care During Plastic Surgical Procedures?

Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.

“GossiPyboma” a retained post-operative intra-abdominal surgical sponge can lead to septicemia and septic shock: A case report

“GossiPyboma” a retained post-operative intra-abdominal surgical sponge can lead to septicemia and septic shock: A case report

Textiloma Misdiagnosed as Paraspinal Abscess During the Period of COVID-19 Pandemic: Case Report

Retained surgical sponge and consequent foreign body reaction is a well-documented complication. In the current literature, the phenomenon has many names such as textiloma, gossypiboma, gauzoma, and muslinoma. While it is one of the widely reported topics, only a few cases are reported by neurosurgeons. Herewith we present a case of textiloma in Turkey who had repeated surgical interventions at various hospitals during the COVID-19 pandemic, possibly due to breakdown of preventive measures against retention of surgical sponge.

Posttraumatic pneumonectomy and management of severely contaminated pleural space.

Posttraumatic pneumonectomy and management of severely contaminated pleural space.

Rare case of gossypiboma as antiboma [Sterile chronic abcess] after twelve year of vaginal hystrectomy and laparoscopy approach

Gossypiboma is used to describe a retained cotton matrix surgical material in the body after an operation. Retained intra-abdominal surgical sponge is an uncommon surgical error. Among retained foreign bodies a surgical or sponge constitutes the most frequently encountered object because of its common usage, small size and amorphous structure We 1st time report a case of 46 yrs old female patient of Gossipiboma with chronic abscess [Antiboma] 12 yrs after vaginal hysterectomy best managed by laparoscopy approach.

Thirty-three-year-old textiloma found during exploratory laparotomy: a case report

The problem caused by a retained surgical sponge is known as a textiloma. Surgical gauze pads can be easily retained due to their ubiquitous use, their relatively small size, and when soaked in blood, making them difficult to distinguish from surrounding tissues. In most cases, the diagnosis of a textiloma is usually given in the following days of a surgical intervention, but there are few cases reported in the literature where a textiloma persists for a variable number of years. A 63-year-old female with a surgical history of a caesarean section 33 year ago complaining of an abdominal palpable mass and chronic abdominal pain. CT scan findings suggested the diagnosis of textiloma, the exploratory laparotomy revealed an encapsulated mass which was completely excised, and intraoperative study confirmed the diagnosis of textiloma. Textilomas occur infrequently and can be a source of great concern to the surgeon and the patient. Foreign bodies within body cavities and organs can present with several nonspecific clinical features that can make diagnosis difficult. An aseptic fibrotic reaction causes that the textilomas can remain asymptomatic for many years, with very few cases of 30 or more years old textilomas reported in the literature. Surgical removal remains as the treatment of choice. Textiloma can be a life-threatening problem that is an avoidable complication. Textilomas should be part of the differential diagnosis of abdominal tumors even after a 30-year surgical history.

Successful laparoscopic removal of gossypiboma: A case report.

Introduction and importanceGossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe systemic or regional symptoms. Traditionally, every RFB must be removed with a surgical procedure. In the era of minimally invasive surgery, laparoscopic removal is a good choice for these problems.Case presentationA young woman was referred to us with intermittent vague abdominal pain and a history of open cholecystectomy. After initial imaging, we found a twisted string-like object in epigastrium. Considering clinical findings and imaging, the patient was taken to the operating room with a diagnosis of RFB. After an explorative laparoscopy, we found an encapsulated fibrotic mass around a surgical sponge with pus-like secretions.ConclusionAfter diagnosing either RFB or gossypiboma, surgical intervention is mandatory, even in asymptomatic patients. Laparoscopy can help the surgeon to remove the retained item safely. Also, decreased length of stay and postoperative pain are significant advantages of laparoscopic removal.

Experimental Evaluation of Chitosan Membrane and Collagen Sponge (TachoSil®) as Sealants in Cardiovascular Surgery.

IntroductionThe objectives of this study are to experimentally evaluate the haemostatic effects of two organic substances, a membrane of chitosan and a collagen sponge coated with thrombin and human fibrinogen (TachoSil®), in sealing 7-0 needle stitches holes on the femoral arteries of rats as well as to evaluate local histological reactions.MethodsTwenty-four rats were included, and four holes were made in each common femoral artery. In the control group, haemostasis was achieved only by compression with gauze sponge; and in the two other groups, haemostasis was achieved with application of one of these two substances.ResultsMembrane of chitosan and TachoSil® showed a power to reduce the time to achieve haemostasis compared with the control group (P=0.001), and the haemostatic effects of these two substances were comparable. There was lower blood loss in the groups where these two substances were used when compared with the control group, but no difference was found comparing the two substances.ConclusionThe use of these sealants did not promote more adhesion or local histological reactions when compared to the control group. Since chitosan is easy to find in nature, has a positive effect to promote haemostasis, and did not bring considerable local reactions, it might be used as a sealant in cardiovascular surgery.

Limitations of Gravimetric Quantitative Blood Loss during Cesarean Delivery

Objective This study examined the accuracy, sources of error, and limitations of gravimetric quantification of blood loss (QBL) during cesarean delivery. Study Design Blood loss determined by assays of the hemoglobin content on surgical sponges and in suction canisters was compared with QBL in 50 parturients. Results QBL was moderately correlated to the actual blood loss ( r = 0.564; p < 0.001). Compared with the reference assay, QBL overestimated blood loss for 44 patients (88%). QBL deviated from the assayed blood loss by more than 250 mL in 34 patients (68%) and by more than 500 mL in 16 cases (32%). Assayed blood loss was more than 1,000 mL in four patients. For three of these patients, QBL was more than 1,000 mL (sensitivity = 75%). QBL was more than 1,000 mL in 12 patients. While three of these had an assayed blood loss of more than 1,000 mL, 9 of the 46 patients with blood losses of less than 1,000 mL by the assay (20%) were incorrectly identified as having postpartum hemorrhage by QBL (false positives). The specificity of quantitative QBL for detection of blood loss more than or equal to 1,000 mL was 80.4%. Conclusion QBL was only moderately correlated with the reference assay. While overestimation was more common than underestimation, both occurred. Moreover, QBL was particularly inaccurate when substantial bleeding occurred. Key Points QBL is inaccurate in cesarean delivery.QBL deviated from the assay result by more than 500 mL in 32% of cases.QBL sensitivity and specificity for hemorrhage is 75.0% (95% confidence interval [CI]: 0.19–0.93) and 80.4% (95% CI: 0.69–0.92), respectively.

Human Skin Explant Preparation and Culture.

The ex vivo experimentation with surgically discarded human skin represents a unique methodology amenable for mechanism and pharmacologic agent studies without the involvement of human subjects. Here, we describe a protocol that includes preparation, culture, and stimulation of human skin explants, and subsequent analyses by quantitative reverse transcription PCR and immunostaining. This protocol may also be applied for ex vivo studies of murine skin, reducing animal numbers and potentially harmful treatments. In our hands, this protocol has been used for wound healing, viral infection, and hair growth-related studies. Graphical abstract: Cartoon of explant skin culture. Skin explant sits on top of a gelatin surgical sponge saturated with culture medium at an air-liquid interface.

A case of laparoscopically removed foreign body granuloma due to surgical sponge (so-called gauzeoma) retained for 21 years

A case of laparoscopically removed foreign body granuloma due to surgical sponge (so-called gauzeoma) retained for 21 years

Gossypiboma as a Rare Cause of Small Bowel Obstruction: A Case Report

Unintentionally retained textile foreign bodies in the abdomen after laparotomy is a serious medical error, with unknown incidence which can lead to severe complications. We present the case of a 24-year-old woman with a retained surgical sponge migrated into the jejunal lumen and causing an intestinal obstruction. Removal of the foreign body required repeated laparotomy and segmental resection of the affected intestinal loop. The article provides the analysis of the imaging diagnostic results, as well as possible reasons that led to the foreign body being left unintentionally. Reliable reduction of incidence and severity of consequences after retention of textile surgical objects in the abdomen can only be achieved through improved standards of patient safety, including careful sponge counting and the routine use of materials with radiopaque markers.

Flexible biomimetic hollow Al2O3 fibers for safe and effective hemostasis

Uncontrolled hemorrhage due to trauma and post-traumatic fibrin dysfunction is a significant cause of death worldwide, and an effective hemostatic material is needed to achieve safe and portable hemostasis in situation of both healthy blood coagulation and fibrin dysfunction. Besides, it is desirable to develop a hemostat material that is active despite long-term storage at harsh temperatures to meet the need of using in harsh condition. Here, biomimetic “cotton-like” hollow Al2O3 fibers (HFs) are fabricated, whose clotting strategy is incompletely dependent on the physiological coagulation mechanisms, to address the above challenges. The HFs, with hollow porous 3-dimensional (3D) structure, large specific surface area and negatively Zeta potential, can not only concentrate blood components, activate intrinsic coagulation pathway, and promote the activation of platelets and fibrin but entrap anticoagulated blood components in a network of HFs to form HFs-based clots with similar morphological characteristics to fibrin-based clots even after exposure to harsh environments. The application of HFs can accelerate hemostasis as compared to gauze, cotton, and hemostatic sponge. The outstanding hemostatic efficacy, in combination with biocompatibility, thermal robustness, portable application and simple fabrication make HFs a promising hemostatic agent for effective and cheap hemorrhage control.

Chitin/corn stalk pith sponge stimulated hemostasis with erythrocyte absorption, platelet activation, and Ca2+-binding capabilities

Chitin (CT) is widely used as a hemostatic material in surgical sponges, although its efficacy needs improvement to promote the clotting process. In this study, another green biomass, corn stalk pith (CSP), was incorporated into CT through ball milling to fabricate CT-CSP composite hemostatic sponges to enhance erythrocyte absorption, platelet activation, and clotting factor accumulation (Ca2+). In vitro hemostatic analysis indicated that CSP incorporation greatly promoted the coagulation process, with a much lower blood clot index and higher blood clot stability. In addition, the composite sponge promoted more platelet adhesion and activation, and the composite sponge demonstrated a greater ability to bind clotting factors (Ca2+). Consistently, it achieved complete hemostasis with less blood loss and a shorter hemostatic time in a rat liver injury-model. This composite hemostatic sponge is sustainable, cost-efficient, and biocompatible, which highlight the excellent translational potential in clinical settings.

Paracardiac Gossypiboma after Coronary Artery Bypass Grafting Surgery

A 54-year-old male patient underwent coronary artery bypass graft surgery. No complications occurred after the surgery. Control posteroanterior thorax X-ray showed a mass lesion with radiopaque linear densities superposed with the left ventricle. A mass lesion containing linear metallic densities was seen adjacent to the left ventricular free wall in the thorax computed tomography images (Figure 1). The appearance was consistent with a retained surgical sponge.