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Retained surgical sponge (gossypiboma) and other retained surgical items: Prevention and management

Annesley W Copeland, MD, FACS
Section Editor
Hilary Sanfey, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


The term retained surgical item refers to any surgical sponge, instrument, tool, or device that is unintentionally left in the patient at the completion of the operation after closure of the wound. Retained surgical item is the preferred term (rather than retained foreign body) to distinguish it from other objects that may be found or left in a patient, such as shrapnel [1]. Surgical sponges are more commonly retained compared with other items used in surgery.

Retained surgical items are rare medical errors that have the potential to cause significant harm to the patient and carry profound professional and medico-legal consequences to physicians and hospitals. Risk factors for this problem are well described and include both patient care processes and working environment issues.

Although there are no known measures to completely eliminate the risk, preventive strategies aim primarily to increase awareness. Some newer technologies are available and show promising results but have not been widely adopted. The definition, types, incidence, risk factors, complications and prevention strategies will be reviewed here.


The most commonly retained surgical item is a woven cotton surgical sponge, which includes both laparotomy pads and smaller sponges (eg, Ray-tec) [2,3]. Sponges are easily retained because of their ubiquitous use, relatively small size, and because, when soaked in blood, sponges conform to and can be difficult to distinguish from surrounding tissues.

The problem of retained surgical sponge is known as gossypiboma, and also as "textiloma", "gauzoma", or "muslinoma." The word gossypiboma may have been formed from the Latin "gossypium" meaning "cotton" and Swahili "boma" meaning "place of concealment" [4]. Others indicate "-oma" was added to gossypi to indicate a growth, as in the example textiloma [4].


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Literature review current through: Sep 2016. | This topic last updated: Sep 23, 2016.
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  1. Gibbs VC. Retained surgical items and minimally invasive surgery. World J Surg 2011; 35:1532.
  2. Williams RG, Bragg DG, Nelson JA. Gossypiboma--the problem of the retained surgical sponge. Radiology 1978; 129:323.
  3. Lincourt AE, Harrell A, Cristiano J, et al. Retained foreign bodies after surgery. J Surg Res 2007; 138:170.
  4. Quinion M. World Wide Words. Copyright 1996-2011. http://www.worldwidewords.org/weirdwords/ww-gos1.htm (Accessed on September 15, 2014).
  5. Berkowitz S, Marshall H, Charles A. Retained intra-abdominal surgical instruments: time to use nascent technology? Am Surg 2007; 73:1083.
  6. Ahmed F, Swan MC, Flynn M, Tiernan EP. Retained VAC therapy sponge as a complication of abdominoplasty. J Plast Reconstr Aesthet Surg 2010; 63:e497.
  7. Leijnen M, Steenvoorde P, van Doorn LP, et al. A Non-healing Sinus of the Lower Leg 5 Years After Vacuum-assisted Closure Therapy Due To a Gossypiboma. Wounds 2007; 19:227.
  8. Hempel S, Maggard-Gibbons M, Nguyen DK, et al. Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events. JAMA Surg 2015; 150:796.
  9. Gawande AA, Studdert DM, Orav EJ, et al. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003; 348:229.
  10. Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg 2008; 207:80.
  11. Hyslop JW, Maull KI. Natural history of the retained surgical sponge. South Med J 1982; 75:657.
  12. Teixeira PG, Inaba K, Salim A, et al. Retained foreign bodies after emergent trauma surgery: incidence after 2526 cavitary explorations. Am Surg 2007; 73:1031.
  13. Camp M, Chang DC, Zhang Y, et al. Risk factors and outcomes for foreign body left during a procedure: analysis of 413 incidents after 1 946 831 operations in children. Arch Surg 2010; 145:1085.
  14. Wan W, Le T, Riskin L, Macario A. Improving safety in the operating room: a systematic literature review of retained surgical sponges. Curr Opin Anaesthesiol 2009; 22:207.
  15. Naama O, Quamous O, Elasri CA, et al. Textiloma: an uncommon complication of posterior lumbar surgery. J Neuroradiol 2010; 37:131.
  16. Mouhsine E, Halkic N, Garofalo R, et al. Soft-tissue textiloma: a potential diagnostic pitfall. Can J Surg 2005; 48:495.
  17. Kim AK, Lee EB, Bagley LJ, Loevner LA. Retained surgical sponges after craniotomies: imaging appearances and complications. AJNR Am J Neuroradiol 2009; 30:1270.
  18. Haegeman S, Maleux G, Heye S, Daenens K. Textiloma complicated by abscess-formation, three years after surgical repair of abdominal aortic aneurysm. JBR-BTR 2008; 91:51.
  19. El Khoury M, Mignon F, Tardivon A, et al. Retained surgical sponge or gossypiboma of the breast. Eur J Radiol 2002; 42:58.
  20. Song SY, Hong JW, Yoo WM, Tark KC. Gossypiboma after mandibular contouring surgery. J Craniofac Surg 2009; 20:1607.
  21. Stawicki SP, Evans DC, Cipolla J, et al. Retained surgical foreign bodies: a comprehensive review of risks and preventive strategies. Scand J Surg 2009; 98:8.
  22. Stawicki SP, Moffatt-Bruce SD, Ahmed HM, et al. Retained surgical items: a problem yet to be solved. J Am Coll Surg 2013; 216:15.
  23. Gibbs VC, McGrath MH, Russell TR. The prevention of retained foreign bodies after surgery. Bull Am Coll Surg 2005; 90:12.
  24. http://www.aornstandards.org/content/1/SEC19.extract (Accessed on June 21, 2016).
  25. Putnam K. Guideline for prevention of retained surgical items. AORN J 2015; 102:P11.
  26. http://www.aornstandards.org/content/1/SEC19.extract (Accessed on June 10, 2016).
  27. Greenberg CC, Gawande AA. Beyond counting: current evidence on the problem of retaining foreign bodies in surgery? Ann Surg 2008; 247:19.
  28. AORN Recommended Practices Committee. Recommended practices for sponge, sharps, and instrument counts. AORN J 2006; 83:418, 421.
  29. http://nothingleftbehind.org (Accessed on January 22, 2016).
  30. The Joint Commission. Frequently asked questions: retained foreign body after surgery. Sept 2007. http://www.jointcommission.org/assets/1/18/retained_foreign_objects_faqs.pdf (Accessed on January 22, 2016).
  31. Steelman VM, Schaapveld AG, Perkhounkova Y, et al. The Hidden Costs of Reconciling Surgical Sponge Counts. AORN J 2015; 102:498.
  32. Stawicki SP, Cook CH, Anderson HL 3rd, et al. Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval. Am J Surg 2014; 208:65.
  33. Steelman VM, Cullen JJ. Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect analysis. AORN J 2011; 94:132.
  34. Egorova NN, Moskowitz A, Gelijns A, et al. Managing the prevention of retained surgical instruments: what is the value of counting? Ann Surg 2008; 247:13.
  35. Greenberg CC, Regenbogen SE, Lipsitz SR, et al. The frequency and significance of discrepancies in the surgical count. Ann Surg 2008; 248:337.
  36. Christian CK, Gustafson ML, Roth EM, et al. A prospective study of patient safety in the operating room. Surgery 2006; 139:159.
  37. McIntyre LK, Jurkovich GJ, Gunn ML, Maier RV. Gossypiboma: tales of lost sponges and lessons learned. Arch Surg 2010; 145:770.
  38. Greenberg CC, Diaz-Flores R, Lipsitz SR, et al. Bar-coding surgical sponges to improve safety: a randomized controlled trial. Ann Surg 2008; 247:612.
  39. Cima RR, Kollengode A, Clark J, et al. Using a data-matrix-coded sponge counting system across a surgical practice: impact after 18 months. Jt Comm J Qual Patient Saf 2011; 37:51.
  40. Westra BL. Radio frequency identification. Am J Nurs 2009; 109:34.
  41. Macario A, Morris D, Morris S. Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology. Arch Surg 2006; 141:659.
  42. Steelman VM. Sensitivity of detection of radiofrequency surgical sponges: a prospective, cross-over study. Am J Surg 2011; 201:233.
  43. van der Togt R, van Lieshout EJ, Hensbroek R, et al. Electromagnetic interference from radio frequency identification inducing potentially hazardous incidents in critical care medical equipment. JAMA 2008; 299:2884.
  44. Rupp CC, Kagarise MJ, Nelson SM, et al. Effectiveness of a radiofrequency detection system as an adjunct to manual counting protocols for tracking surgical sponges: a prospective trial of 2,285 patients. J Am Coll Surg 2012; 215:524.
  45. Seidman SJ, Brockman R, Lewis BM, et al. In vitro tests reveal sample radiofrequency identification readers inducing clinically significant electromagnetic interference to implantable pacemakers and implantable cardioverter-defibrillators. Heart Rhythm 2010; 7:99.
  46. Inaba K, Okoye O, Aksoy H, et al. The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery. Ann Surg 2016; 264:599.
  47. Regenbogen SE, Greenberg CC, Resch SC, et al. Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness. Surgery 2009; 145:527.
  48. Dossett LA, Dittus RS, Speroff T, et al. Cost-effectiveness of routine radiographs after emergent open cavity operations. Surgery 2008; 144:317.
  49. Williams TL, Tung DK, Steelman VM, et al. Retained surgical sponges: findings from incident reports and a cost-benefit analysis of radiofrequency technology. J Am Coll Surg 2014; 219:354.
  50. Rappaport W, Haynes K. The retained surgical sponge following intra-abdominal surgery. A continuing problem. Arch Surg 1990; 125:405.
  51. Yildirim S, Tarim A, Nursal TZ, et al. Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg 2006; 391:390.
  52. Manzella A, Filho PB, Albuquerque E, et al. Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol 2009; 193:S94.
  53. Vallerie AM, Herzog TJ, Wright JD. Postpartum sterilization: small incision, big complication. Obstet Gynecol 2008; 112:353.
  54. Deger RB, LiVolsi VA, Noumoff JS. Foreign body reaction (gossypiboma) masking as recurrent ovarian cancer. Gynecol Oncol 1995; 56:94.
  55. Vento JA, Karak PK, Henken EM. Gossypiboma as an incidentaloma. Clin Nucl Med 2006; 31:176.
  56. Yuh-Feng T, Chin-Chu W, Cheng-Tau S, Min-Tsung T. FDG PET CT features of an intraabdominal gossypiboma. Clin Nucl Med 2005; 30:561.
  57. Kim CK, Park BK, Ha H. Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J Roentgenol 2007; 189:814.
  58. Shyung LR, Chang WH, Lin SC, et al. Report of gossypiboma from the standpoint in medicine and law. World J Gastroenterol 2005; 11:1248.
  59. Lauwers PR, Van Hee RH. Intraperitoneal gossypibomas: the need to count sponges. World J Surg 2000; 24:521.
  60. Singh R, Mathur RK, Patidar S, Tapkire R. Gossypiboma: its laparoscopic diagnosis and removal. Surg Laparosc Endosc Percutan Tech 2004; 14:304.
  61. Rodrigues D, Perez NE, Hammer PM, Webber JD. Laparoscopic removal of a retained intra-abdominal ribbon malleable retractor after 14 years. J Laparoendosc Adv Surg Tech A 2006; 16:369.
  62. The Joint Commission. Sentinel Event Data. Nov 2015. http://www.jointcommission.org/assets/1/18/Event_Type_by_Year_1995-3Q-2015.pdf (Accessed on January 22, 2016).
  63. Orosco RK, Talamini J, Chang DC, Talamini MA. Surgical malpractice in the United States, 1990-2006. J Am Coll Surg 2012; 215:480.
  64. Mehtsun WT, Ibrahim AM, Diener-West M, et al. Surgical never events in the United States. Surgery 2013; 153:465.
  65. Kaiser CW, Friedman S, Spurling KP, et al. The retained surgical sponge. Ann Surg 1996; 224:79.
  66. Jackson, JZ. A primer on the unhappy defense of the surgeon in a retained sponge case. Med Law Update 2003; 3:10.