Retained surgical foreign bodies: a comprehensive review of risks and preventive strategies.

Given the increasing complexity of both the modern health care environment and the overall patient population, reduction of medical errors is a high priority task for health policy makers and medical/surgical community alike. The problem of retained surgical foreign bodies (RSFB) has existed ever since the humans first performed surgical procedures. Retained surgical foreign bodies continue to be a significant problem with an incidence between 0.3 and 1.0 per 1,000 abdominal operations. Retained surgical foreign bodies have the potential to cause harm to the patient and carry profound professional and medico-legal consequences to surgical trainees, surgical practitioners, hospitals, and health systems. Currently, there are no known methods of entirely eliminating the occurrence of RSFB. In this manuscript, the authors discuss the available evidence with regards to risk factors associated with RSFB as well as methods of minimizing the incidence of RSFB. Modern technological advances designed to decrease the incidence of RSFB (radio-frequency tagging of surgical sponges) and improved perioperative patient processing (multiple 'checks and balances' and better provider-to-provider communication) are reviewed. The authors also explore the relationship between RSFB and surgical training with emphasis on education in early recognition, prevention, and focus on team-oriented training strategies.

Splenic injury after intraoperative transesophageal echocardiography.

A 55-year-old woman underwent coronary artery bypass grafting and mitral valve repair using intraoperative transesophageal echocardiography (TEE). Postoperatively she had hemodynamic instability associated with an increase in abdominal size and a drop in hemoglobin. At laparotomy, a splenic hilar laceration was discovered, which was presumed to be associated with intraoperative TEE. She underwent emergent splenectomy. This case demonstrates that although rare, serious complications can occur with TEE.

Laparoscopic resection of benign stromal tumor of the stomach.

Laparoscopic surgery has recently become commonplace in the general surgeon's armamentarium of surgical approaches to many problems. This has been seen most notably with laparoscopic cholecystectomies. Herein is reported a case of an incidental benign stromal tumor of the stomach being resected laparoscopically.

Laparoscopic herniorrhaphy versus traditional open repair at a community hospital.

Over a 2-year period 157 inguinal hernias in 151 patients were consecutively entered in this descriptive, observational study to determine any difference in outcome between a laparoscopic inguinal hernia repair versus an open inguinal hernia repair in a community hospital setting. The laparoscopic transabdominal preperitoneal technique was utilized in 50 cases. A conventional open repair was used in 107 cases. There were statistically significant differences when the laparoscopic and open groups were compared for the number of days until driving a car (p < 0.01), the number of days until getting in and out of bed comfortably (p = 0.01), the number of days until working on a limited basis (p = 0.01), and the number of days until working on a full-time basis (p < 0.05), although these differences may be due to confounding factors in this nonrandomized study. The average length of operating time was 72.2 min laparoscopic versus 51.6 min open (p < 0.001). We have shown that laparoscopic inguinal hernia repairs may have benefits over conventional hernia repairs. This may make its use more widespread than it has already become.