Surgical Sponges. In most surgical procedures they are essential. They help us visualize tissues and structures, help with hemostasis, help us retract tissue, and can be incredibly useful in dissection and other surgical procedures.  However, when they are covered in blood they can be hard to find which threatens the success of the surgical procedure.

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A retained surgical sponge can lead to disastrous consequences. 

The technical term for a mass of cotton material, usually, gauze, sponges and towels, inadvertently left in the body cavity at the end of a surgical operation is a gossypiboma.  The sequelae for leaving a surgical sponge behind includes, but is not limited to, infections, exudative reactions, fibrotic reaction, fibrosarcoma, foreign body migration, fistulation, adhesions.

 There is a dearth of information reported in veterinary patients related to retained surgical sponges. One survey study performed on veterinary patients indicated that 70% of the  cases were non-scheduled surgeries. Additionally, another factor identified as increasing the risk of leaving a surgical sponge was having two people in the surgery suite (the surgeon plus one other) as this was found in 15 of the 17 cases. Not performing a sponge count before and after the surgery or incorrectly performing the sponge cont was identified as another factor which can increase the risk.   Although that particular survey study had a low response rate and may have duplicate respondents, some of the conclusions in that survey were similar to human studies on this subject. These studies identified emergency surgery; surgery team fatigue; unexpected intraoperative complications, unplanned procedure, distractions in the operating gallery,  break in normal sequence of procedure, large patients patient obesity, poor communication between the technical staff and surgeons, and staff changes.1

While no surgical team is immune to these dreaded complications, there are steps that you can take to minimize your risk. Evidence-based recommendations combined with clinical experience are the summation of a quasi “whatever works” approach towards minimizing risk of leaving a sponge behind after surgery.   Here are a few suggestions: 

• Keep sponges a certain distance from the incision 

• Communicate with team members regarding where you placed a surgical sponge especially in deep body cavities. 

• Precount sponges (twice) 

• Keep sponges in a centralized location away from the surgery site. 

• When performing abdominal surgery, make use of laparotomy sponges if possible; keep radiopaque sponges to a minimum 

• When performing any soft tissue surgery avoid use of non radio-opaque sponges.

• Perform a Post op sponge count 

• Post op radiographs can be helpful to identify a sponge although retrieving a sponge still requires a second surgery.  

• Swabs should only be used intra-abdominally if they are “mounted on a stick” (ie., cotton tipped applicators) 

• Newer technologies for gauze tracing (i.e. electronic article surveillance systems; radiofrequency) 

 There are a host of other solutions and encourage everyone who does surgery - no matter how much or how little - to contribute the the collective knowledge or risk reduction fro retained surgical sponges. There are o many talented and creative doctors who are finding innovative solutions to this problem. 

Regardless if your solutions are rooted in sponge surveillance or in newer technologies, the techniques are most successful when employed consistently and diligently.  Prevention is priority regarding this condition because treatment involves a secondary surgery, removal of the gossypiboma, and possibly removal of tissue or an entire organ. (i.e. splenic adhesion necessitating a splenectomy)  Awareness, meticulousness of the risk of forgetting a surgical sponge in a body cavity is critical at every moment of every surgery. Taking simple precautions will help decrease or eliminate the risk of retained surgical sponges.