Gossypiboma: a Preventable Continuing Surgical Error

Abstract

Background: Inadvertent retention of gauze and sponge material after surgery is a preventable error that still persists despite laid down protocols for best practice in the theatre suite to eliminate gossypiboma.
Aim: To present twelve cases of gossypiboma managed at the Korle-Bu Teaching Hospital (KBTH) to emphasise the frequency at which gossypiboma is occurring in Accra, highlight the risk factors that contributed to the development of gossypiboma and then stress the importance of strict adherence to theatre protocol to help prevent its occurrence.
Methods: A register to record and follow-up cases of gossypibomas that reported to KBTH was maintained by the authors and these cases were followed throughout their admission and treatment. The surgeons, the theatre nursing staff who treated these patients and the patients themselves were interviewed by the authors. The Patients’ case notes, the theatre and autopsy registers were also consulted for information.
Results: There were nine females and three males aged between 26 and 75 years. Seven of the index operations were performed at the Korle-Bu Teaching Hospital, two each at Municipal and private hospitals and one in a para-statal hospital. Ten followed intra-abdominal operations, six of which were pelvic procedures; four being gynaecological. The contributing factors to the gossypiboma were lack of instrument count (all cases), operating in deep surgical fields (seven cases), operating without the full complement of operating staff (seven cases), extensive surgery (seven cases), excessive bleeding (six cases), emergency procedures done at night, change in part of the operating team without proper handing over and unexpected change in the surgical procedure.
Conclusion: Gossypiboma is not an uncommon condition in the developing world but possibly underreported. The presence of risk factors for its occurrence should prompt the surgeon to take extra precautions in high risk patients and to always insist on strict adherence to operating room protocols especially when the operation is in a body cavity.