Der Chirurg

, Volume 78, Issue 1, pp 7–12 | Cite as

Belassene Fremdkörper – aus der Sicht des Chirurgen

  • K. Schönleben
  • A. Strobel
  • F. Schönleben
  • A. Hoffmann
Leitthema

Zusammenfassung

Das Belassen eines Fremdkörpers ereignet sich wahrscheinlich häufiger, als es die Angaben der Fachliteratur ausweisen. Nach amerikanischen Versicherungsstatistiken liegt die Inzidenz bei etwa 1:1500 Operationen. Grundsätzlich gilt es – auch unter juristischem Aspekt – zu unterscheiden, ob ein Fremdkörper akzidentell (z. B. Materialfehler) in situ verblieben ist oder ob er vergessen worden ist. Zu rund 70% werden textile Materialien (Bauchtücher usw.) vergessen, zu rund 30% metallische Gegenstände. Besondere Risiken dafür bestehen bei Notfalloperationen, ungeplantem Wechsel eines Op.-Verfahrens und erhöhtem BMI. Die gesundheitlichen Folgen sind in Abhängigkeit von Material und individueller Patientensituation unterschiedlich. Metallische Fremdkörper induzieren in der Regel frühe und eher akute Krankheitsbilder, textile Materialien oft chronische Verläufe über Jahre, sofern primär keine bakterielle Kontamination stattgefunden hat. Reoperationen sind mit hoher Mortalität (zwischen 11 und 35%) belastet. Es gilt, Vorbeugemaßnahmen im Rahmen eines diese Facette der Patientengefährdung berücksichtigenden Risk-Managements zu erstellen und v. a. in Risikosituationen stringent einzuhalten. Bild- oder signalgebende Technologien vor Wundverschluss sind zu empfehlen, um den Risikofaktor „human error“ bestmöglich auszuschalten.

Schlüsselwörter

Belassene Fremdkörper Akzidentell Vergessene Fremdkörper Mortalität Risk-Management 

Retained foreign bodies from the surgical point of view

Abstract

The number of foreign bodies remaining in the patient after a surgical procedure is presumably higher than mentioned in the literature. According to US insurance statistics, the incidence amounts to 1 in 1,500 surgical procedures. As a basic principle – also from the legal aspect – it is necessary to determine whether a foreign body was left in situ accidentally (i.e. due to a material fault) or if it was simply forgotten. In 70% of cases, fabric items (e.g. swabs etc.) are left behind, while around 30% are metal objects. A particularly high risk is seen in emergency settings, in unexpected changes in the surgical procedure, or for patients with a high body mass index. The outcome for the patient differs depending on the nature of the object left behind and the individual patient’s situation. Usually, metal items cause more acute clinical symptoms at an earlier time after the operation. Fabric items tend to induce, in the absence of primary contamination, a chronic progression of symptoms over several years. Reoperation has a high mortality (between 11% and 35%). Precautions in terms of risk management have to be established and need to be strictly respected, especially in high risk settings. Visually or acoustically controlled monitoring before wound-closure are recommended to eliminate “human error” as thoroughly as possible.

Keywords

Foreign bodies left behind Accidentally Forgotten foreign bodies Mortality Risk management 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • K. Schönleben
    • 1
  • A. Strobel
    • 1
  • F. Schönleben
    • 2
  • A. Hoffmann
    • 3
  1. 1.Chirurgische KlinikKlinikum LudwigshafenLudwigshafenDeutschland
  2. 2.Chirurgische Klinik mit PoliklinikErlangenDeutschland
  3. 3.Klinik für Beinerkrankungen und EnddarmleidenNürnbergDeutschland

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