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A laparotomy sponge is an absorbent pad used in surgical procedures on the abdomen. They have a number of applications and are a common inclusion in surgical kits laid out to prepare an operating room for a surgery. Manufacturers typically produce several sizes in packages that may or may not come sterilized, allowing operating room technicians to select the most appropriate options for a given surgical case. Laparotomy sponges also enjoy some notoriety, as they are infamous for being accidentally left behind at the end of procedures.
Typical designs include absorbent cotton, usually washed to make sure it can soak up fluids. A common use for a laparotomy sponge is as a tool to absorb fluids around the surgical field. This can make it easier for the surgeon to see. In combination with suction, the sponges can keep the field as dry as possible, allowing the team to clearly visualize the area of interest so they can perform the procedure. Laparotomy sponges can also be used when it’s necessary to apply pressure, as they help distribute the pressure and stop bleeding.
They can also be moistened and used to help retain moisture on a given area of the surgical site. Sterile water or saline is used for this purpose to avoid introducing pathogens to the patient. Moistened sponges can also be used in manual retraction to provide some traction on the tissue so it will be easy to grip without damaging it with dry cotton. The surgeon takes a moist laparotomy sponge in hand and carefully uses it to grasp the tissue of interest to pull it back and see a structure of interest. If necessary, a surgical retractor can be placed to hold the tissue open.
These useful surgical tools can migrate during surgery and it is easy to lose track of them. Evaluation of case histories of surgically retained foreign bodies, as objects left behind after surgeries are known, indicates that the laparotomy sponge is the most common culprit. Hospitals use several techniques to ensure that no sponge is left behind, including counting sponges in and out at the beginning and end of surgery and carefully checking the abdominal cavity for any foreign material.
Some manufacturers make sponges with radio-opaque tapes or strands of thread. The patient can be x-rayed to check for sponges before closing the surgical site, ensuring that any stragglers are caught and addressed. These features can also be useful when a patient has symptoms indicative of a retained sponge, like intense abdominal pain and tenderness; an x-ray can quickly determine if a laparotomy sponge is present or if something else is causing the problem.