Textiloma of the abdominal cavity: Summary of PhD Thesis of Medical Sciences. 321.13. – Surgery

Abstract

Actuality and importance of the topic. Modern surgery involves working in a specific environment of the operating room with high levels of stress, pressure and risks accompanying complex technical procedures, as well as under conditions of significant time shortage [1]. A side effect of such intense activity is the constant threat of complications and medical errors [2]. Among the many potential complications, unintentionally leaving surgical objects in the operative field remains one of the most serious, and refers to the so-called “never events”, i.e. that should not occur in any form, being completely preventable and caused exclusively by human errors [3]. However, they do occur, and descriptions of these events continue to appear in both the medical literature and the media press. The most frequent (70-90%) they are textile foreign bodies (TFB) or “textiloma” [4], due to their common use in all surgeries, amorphous structure and variable size, shape and color, especially when the sponge is soaked with blood and becomes difficult to distinguish in the operative field [2, 5]. More than 50% of all incidents of remaining TFBs were recorded after abdominal surgery, due to the large volume and anatomical complexity of the abdominal and pelvic cavities [6]. The real incidence of abdominal textiloma is unknown and can hardly be accurately determined due to medical and legal issues. However, according to the most reliable estimates, the morbidity from abdominal textiloma is about one case in 1,000-1,500 abdominal surgeries [5, 7]. Textile objects retained in the abdominal cavity after surgery can cause various complications, sometimes extremely severe and even fatal [7, 8]. In addition to acute complications requiring urgent relaparotomy, the possibility of a foreign body is rarely considered in the diagnosis of an abdominal mass, leading to unnecessary examinations, invasive procedures, and radical surgeries [1, 9]. Theoretically, textiloma can be diagnosed using radiography, ultrasonography (USG), computed tomography (CT) and other imaging methods [10, 11]. However, the visual characteristics of abdominal TFB are not well defined and, due to the rarity of pathology, they are little known by a radiologist, that is why they are misinterpreted, and patients are often admitted with other competing diagnoses. In addition to medical aspects, TFBs left in the abdominal cavity can have serious ethical and legal implications, leading to devastating consequences for the operating surgeon and medical institution [6]. Current ethical and legal norms require recognition, mandatory documentation and information of patient regarding TFBs retention, which implies additional explanations, some punishment of involved personnel, potential litigation and payment of all costs incurred as a result of the incident [2, 3]. Finally, cases of abdominal TFBs are generally underreported, due to the reluctance of clinicians and hospitals to disclose these types of errors [1, 11]. Therefore, the development and implementation of reliable and standardized safety methods is of primary importance, which should aim to eliminate or minimize accidental injury to patients during the time spent in the operating room, including erroneous retention of textile objects in the abdominal cavity [1, 3]. However, remain unclear the incidence of abdominal textiloma in daily practice of surgeons, as well as their theoretical competence and actual execution of the current ethical norms in occurrence of event. The specific clinical manifestations of abdominal textiloma and their dependence on interval of TFB retention, the type of individual response to a foreign body and development of potential complications are not fully established. The risk factors that may contribute to retention of TFB in the abdomen, as well as the possibility of monitoring and managing them in order to reduce morbidity, have not been sufficiently identified. The comparative value of different diagnostic imaging methods has not been completely studied, while visual characteristics of abdominal textiloma and their relationship with clinical manifestations and patient history are not clear. The clinical scenarios for decision-making to remove the textiloma from the abdominal cavity, the optimal type and volume of surgical procedure, as well as the frequency and nature of postoperative complications were ultimately not determined. The role of individual, procedural and organizational errors in cases of abdominal TFB remains unclear, although it is indisputable that the development and strict adherence to preventive measures can improve the level of surgical patient safety. Aim of study: To improve the accuracy of diagnosis and treatment results of abdominal textiloma based on identification of characteristic clinical and imaging manifestations, as well as the potential reduction of morbidity by developing and standardizing preventive measures. Objectives of study: 1. Identification of suggestive clinical manifestations of abdominal textiloma and their dependence on the duration of retention, type of individual reaction to a foreign body, as well as the possible occurrence of complications. 2. Establishing significant risk factors for accidental retention of textile objects in the abdominal cavity during surgery, as well as possible measures for their control and management. 3. Determination of characteristic visual signs of abdominal textiloma, using different medical imaging methods, and assessment of their informative value. 4. Optimizing the indications and volume, and specifying the technical characteristics of surgical intervention for removal of abdominal TFB, as well as determining the particularities of postoperative period depending on type of textiloma and severity of intraoperative events. 5. Studying theoretical knowledge and real compliance by surgeons to the requirements of actual medical ethics regarding cases of unintentional retention of TFB in the abdominal cavity. 6. Development of the complex actions aimed at optimizing organizational and procedural measures in the operating room, and to prevent unintentional retention of TFB in the abdomen.