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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 medicolegal consequences to physicians and hospitals. In addition, these events and strategies to prevent them increase the cost of health care delivery. Costs associated with retained surgical items include loss of the reimbursement for the procedure itself, those associated with additional hospitalization or readmission to manage the problem, litigation, and malpractice settlements.

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: Nov 2017. | This topic last updated: Nov 17, 2017.
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