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Left
behind part of instrument during elective
laparoscopic
bariatric procedure
O. Avrutis, O. Sibirsky, J.
Meshoulam, V. Michalevsky, A. Durst
Bikur Cholim
Hospital, Jerusalem
Background: The incidence of the retention
of a foreign body in abdominal operations varied from 1 in 1000 to 1 in 1500 procedures.
Reasons for retained instruments after surgical interventions remain
unclear. One well designed and controlled study claimed forgetting
instruments and sponges were more common in emergency operations, unplanned
changes in the course of the procedures and high BMI. There are few if any
reports regarding these errors in laparoscopic surgery.
Case report: A 27 year-old woman was
referred to our department with intolerance to Gore-Tex nonadjustable
gastric band implanted laparoscopically for morbid obesity (BMI 43) nine
months ago. Laparoscopic debanding was performed successfully. On the next
day, swallow study detected a large metal foreign body in the right subphrenic
area. It was looking as a part of Abdo-Lift (Karl Storz), a tool obviously
using during laparoscopic gastric banding performing in the other hospital.
CT scan depicted the foreign body laying free in the abdominal cavity. This
15cm long part of broken appliance was removed laparoscopically. Presented
Video shows the details of this unique case.
Conclusion: Laparoscopic instruments
might be left behind during procedures in spite of small incisions using in
laparoscopy. It is necessary to count and check instruments in laparoscopic
procedures as in open surgery.
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