Copyright (c) 2010 Julie Glynn

If you are attending hospital for an operation you probably would not give a lot of thought to a surgical instrument being left inside you during the process of the operation. However, an estimated 1 in 9,000 to 1 in 18,000 operations result in surgical equipment being left behind before closing incisions. In these situations, 70% represent retained swabs used during the course of the operation, and the remainder are instruments.

Once the operation has been concluded the next question is how the retained item will manifest itself. There are two common methods for it to become obvious that not everything that should have been removed during the operation was actually removed. The first and most common method includes signs of acute sepsis or even protrusion of the foreign body through the wound. This is usually picked up quite quickly as the medical team will be monitoring the area in question for some time after the operation.

A long term presentation can be more difficult to diagnose. In these situations the retained item might result in abdominal pain or discomfort, nausea, constipation, weight loss or a feeling of pelvic pressure. More serious symptoms may result from abscess formation, fistulas and bowel obstructions or perforations.

These errors are more common after emergency surgery, an unplanned intra-operative change of procedure, changes in theatre staff and failure to count swabs in and out. An operation by a single surgeon carries a greater risk than when a team is involved.

The key to avoiding trouble is : -

* Performing more than one in and out swab count (i.e. double checking to ensure that all swabs have been removed);

* Having an adequate number of experienced staff (obviously staff shortages or cut backs might lead to less staff which increases the chances of negligence);

* Replacing small swabs by laparotomy pads;

* Completely searching the abdomen before closure of the wound.

However, in one study of successfully litigated cases a correct count of swabs had been noted in 88% of these cases. This has led to a call for bar coded swabs which can be scanned on entry and exit to avoid these human errors which are clearly still far too prevalent.

If you have received medical treatment and have had symptoms similar to those above after leaving hospital you should immediately seek further medical advice. It is important that any retained swabs or instruments are removed as quickly as possible to ensure that they do not cause further damage.

If you have been the victim of a retained item after surgery you should seek urgent legal advice from specialist medical negligence solicitors to discover your options. Most specialist medical negligence firms should be able to provide you with free initial medical advice.