Leaving a foreign object in the body of a patient during abdominal surgery: still a current problem

Abstract

Introduction: Leaving a foreign object (retained the surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated phenomenon which is dangerous to the health of the patient and the legal security of medical personnel. These adverse events are easy to avoid through the use of appropriate means of prevention. The aim of the present paper is the collection of epidemiological data and determination of risk factors, symptomatology, health effects, and prevention methods associated with RSIs. Material and methods: Analysis of global scientific publications in the databases PubMed, ClinicalKey, Google Scholar, ScienceDirect, and Scopus related to the subject of RSIs. Results: The frequency of RSI incidents ranges from 1 to 10 in 10,000 intra-abdominal surgeries, which results in at least one case in an average multispeciality hospital on a yearly basis. The items most frequently left behind include soft foreign objects, such as swabs and bandages (90%). Risk factors include emergency surgical procedures, high patient BMI, significant loss of blood during surgery, and neglect in counting material and surgical tools. The postoperative course, although in many cases asymptomatic, may be complicated by inflammation, bleeding, or perforation, leading to the necessity of a second operation and, in 2 to 4% of cases, even ending in death. Imaging tests are effective diagnostic tools. Effective methods of preventing RSIs are based on checklists and systems for counting and monitoring the location of material and tools. Conclusions: The globally occurring problem of RSIs requires the education of operating block personnel regarding risk factors and the identification and elimination of adverse events of this type. Diagnostics based on imaging should take into account non-specific complaints resulting from a possible oligosymptomatic course. An RSI should not be regarded as a medical error. Changes in the perception of the phenomenon are aimed at minimizing the legal liability of staff in the event of leaving a foreign object in the patient’s body.