Skip to main content

Laparotomy Pads

Large multi-layered woven cotton surgical sponges (lap pads, lap sponges, abdominal packs), with common sizes of 18 × 18 in and 4 × 18 in, are used in open RU, urogyn and general operations for fluid absorption, visceral retraction, hemostatic packing, field isolation and gravimetric blood-loss quantification. Select X-ray-detectable products for the surgical wound; some model lines also include radiofrequency-detection (RFD) tags as an adjunct to counting.[1][2][3][4][17][18]

Design​

  • Multi-layered woven cotton, hemmed edges and large absorbent surface area; sizes and supplied sterile or nonsterile status vary by catalog item.[18]
  • Radiopaque marker (barium-sulfate–impregnated strip or thread), detectable on plain radiograph and fluoroscopy.[1][2][3]
  • Radiofrequency-detection (RFD) tag in specified models. The Inaba emergency-surgery series reported $0.17 additional cost per 4 × 18 sponge and 11 preclosure detections among 2,051 patients, with no missed sponges reported in that series; this does not establish universal 100% sensitivity.[4][18]
  • Tracking tail or loop when supplied. Some 18 × 18 models explicitly have no loop; account for every pad in the count rather than assuming an external tail.[18]

Reconstructive-Urology and Urogyn Uses​

Visceral retraction during open / hand-assisted urogyn / RU surgery​

  • Small-bowel and sigmoid retraction out of the pelvis during open sacrocolpopexy, abdominal hysterectomy with concomitant urogyn repair, open ureteral reimplantation, Boari flap, ileal-conduit / neobladder construction, augmentation cystoplasty, open RP / RC.
  • Hand-assisted laparoscopic surgery. Surgical towels or lap pads inserted through the hand-access port for visceral retraction.[5]
  • Bladder, ureter, and bowel protection during deep pelvic dissection.

Hemostatic packing — damage-control and obstetric hemorrhage​

  • Abdominopelvic packing for life-threatening coagulopathy. Stone's 1983 historical 31-patient series compared 1/14 survivors after conventional completion with 11/17 after abbreviated surgery, packing and later definitive repair; this is not a randomized estimate of packing's causal survival benefit. Record all intentionally retained packs and the planned return.[6][17]
  • Obstetric hemorrhage from placenta-accreta spectrum. Brown 2025 describes abdominopelvic packing in a video-format report. The same principle of temporizing pressure may be considered in selected life-threatening urologic pelvic bleeding, but that publication does not test the named urogyn or urologic scenarios or prescribe their packing protocol.[7]

Fluid absorption / field management​

  • Continuous absorption of blood and irrigation in the operative field. The larger surface area makes a lap pad the usual choice over 4×4 Ray-Tec sponges when volume is high.

Contamination barrier​

  • Placed over bowel during GI work (eg, ileal-conduit anastomosis, augmentation enterotomy) as a bacterial-strikethrough barrier.
  • Bezhentseva 2022. A veterinary-context in-vitro E. coli/water-on-agar model found less strikethrough with more sponge layers, but growth beneath all 192 inoculated plates; this does not establish a human clinical infection reduction or a sterile seal.[8]

Quantitative Blood-Loss Estimation​

ACOG recognizes weighing blood-soaked materials as one method for obstetric blood-loss quantification, with dry weight and nonblood fluids accounted for; its 2019 opinion does not establish that one quantification method is superior or that quantification alone improves outcomes.[9] Real-world performance caveats:

  • In Holmes's 46 mixed surgical cases, gravimetry of 18 × 18 pads exceeded a rinsed-hemoglobin reference by a mean 466 mL per case; this is not a correction factor for every case or for small gauze.[10]
  • Visual estimation of blood on operating-room materials can be inaccurate. In Vesely 2025, 124 students, residents and attendings viewed photographs of simulated blood on lap pads, Ray-Tecs, towels and drapes. Average estimates exceeded the actual amount for every item; the study was a single-institution survey, not measurement during live surgery.[11]
  • Image-analysis hemoglobin estimates (Triton) correlated r = 0.93 with rinsed hemoglobin in that 46-case study; the endpoint and workflow are not interchangeable with real-time total blood-loss or transfusion decisions.[10]

Retained Surgical Sponge (Gossypiboma) — The Feared Complication​

  • Sponges are a prominent retained-item category; published incidence estimates vary by setting and ascertainment, so a single universal per-operation rate is unreliable.[12]
  • Risk factors. Emergency surgery, unexpected procedural change and increasing BMI in Gawande's case-control analysis. Among retained-object cases with counts performed, 88% had a count reported correct; this selected series does not establish an 88% false-negative rate for all sponge counts. Rupp's prospective miscount cohort associated blood loss and longer or open operations but did not find a BMI association.[13][19]
  • Clinical presentations. Early exudative (abscess, peritonitis) or late aseptic fibrous (adhesions, fistulae to adjacent organs: bladder, bowel, vagina).[1]
  • CT is very useful for recognition, although appearances vary widely and can mimic abscess or hematoma; a radiopaque marker is not a reliable sign.[14]

Prevention — Defense in Depth​

StrategyEvidence
Standardized manual counting before / during / afterCore prevention step, with wound exploration and discrepancy reconciliation; Gawande reported a correct count in 88% of selected retained-object cases for which a count had been performed, not an all-case false-negative rate[13][17]
Radiopaque marker in all body-cavity spongesStandard since the Williams 1978 description[2]
RFD-tagged spongesInaba 2016 prospective emergency-surgery cohort (n = 2,051) — 11 (0.5%) preclosure detections, no missed sponges reported; adjunct technology does not replace counting or prove universal sensitivity[4]
Barcode scanningDetects significantly more count discrepancies than manual counting alone[12]
Intraoperative radiographUse for unreconciled counts and other indications under institutional policy; risk factors can prompt additional verification but do not create a universal imaging mandate[17]

ACS recommends standardized counts, methodical wound exploration, X-ray-detectable items in surgical wounds and X-ray or other detection technology as indicated, with documentation of intentional packing and count discrepancies. The interventional-radiology and historical ACOG statements have different settings and should not be represented as an identical modern operating-room mandate.[15][16][17]

Practical Pearls​

  • Use X-ray-detectable sponges in surgical wounds. Add RFD or barcode when available and supported by local policy, never as a substitute for counts and wound exploration.[17]
  • Track tails or loops when supplied. Keep an attached tail accessible when feasible during temporary packing; no-loop pads require the same explicit count and intentional-packing record.[17][18]
  • Moisten before retraction. This is standard operative teaching to limit serosal trauma; no comparative data are cited here.
  • Layer count when packing pre-emptively for high-risk cases (placenta accreta, ruptured iliac, large retroperitoneal exposure); count is harder during a bleeding emergency.
  • Quantify blood loss with an available validated method while accounting for irrigation and clinical context; Holmes's 466-mL mean gravimetric bias is study-specific and should not determine an individual transfusion decision.[9][10]
  • For damage-control packing, Stone 1983 is a historical conceptual reference for temporizing hemorrhage and planned re-exploration, not a fixed pad count, a contemporary closure-under-tension instruction or a protocol to apply without a multidisciplinary plan. Document intentional packing and its removal plan.[6][17]
  • High-risk or discrepant counts warrant deliberate reconciliation and additional detection or radiography as indicated by local policy; no universal BMI ≥ 30 threshold or all-case radiograph rule was established by the cited case-control study.[13][17]

Limitations​

  • Even RFD-tagged sponges require active scanning. RFD doesn't auto-alert; the wand must be passed before closure.
  • Sponges with broken radiopaque threads may be invisible on radiograph; visual inspection of integrity matters.
  • Bacterial strikethrough occurred even under 6–8 layers in the veterinary in-vitro agar model; this does not quantify human surgical-site infection risk.[8]
  • QBL gravimetric inaccuracy in obstetric / irrigation-heavy cases.

See also: Ring (Sponge) Forceps, Kittner Dissector, Bladder Scanner.

References​

1. Sakorafas GH, Sampanis D, Lappas C, et al. "Retained surgical sponges: what the practicing clinician should know." Langenbecks Arch Surg. 2010;395(8):1001–7. doi:10.1007/s00423-010-0684-4

2. Williams RG, Bragg DG, Nelson JA. "Gossypiboma — the problem of the retained surgical sponge." Radiology. 1978;129(2):323–6. doi:10.1148/129.2.323

3. Wilson OJ, Young BF. "The radio-opacity of surgical and radiological devices used in vivo: a test method for markers in surgical gauze." Phys Med Biol. 1987;32(10):1283–9. doi:10.1088/0031-9155/32/10/007

4. Inaba K, Okoye O, Aksoy H, et al. "The role of radio frequency detection system embedded surgical sponges in preventing retained surgical sponges: a prospective evaluation in patients undergoing emergency surgery." Ann Surg. 2016;264(4):599–604. doi:10.1097/SLA.0000000000001872

5. Nakajima K, Milsom JW, Margolin DA, Szilagy EJ. "Use of the surgical towel in colorectal hand-assisted laparoscopic surgery (HALS)." Surg Endosc. 2004;18(3):552–3. doi:10.1007/s00464-003-8173-2

6. Stone HH, Strom PR, Mullins RJ. "Management of the major coagulopathy with onset during laparotomy." Ann Surg. 1983;197(5):532–5. doi:10.1097/00000658-198305000-00005

7. Brown KS, Goodman L, García G, Einerson BD, Kaiser JE. "Accreta ready: mastering abdominopelvic packing for crisis situations." Obstet Gynecol. 2025;145(6):749. doi:10.1097/AOG.0000000000005908

8. Bezhentseva A, St Germaine LL, Hoffmann DE. "Efficacy of laparotomy sponges to reduce bacterial contamination using an in vitro gastrointestinal surgery model." PLoS One. 2022;17(4):e0267293. doi:10.1371/journal.pone.0267293

9. Committee on Obstetric Practice. "Quantitative blood loss in obstetric hemorrhage: ACOG Committee Opinion No. 794." Obstet Gynecol. 2019;134(6):e150–6. doi:10.1097/AOG.0000000000003564

10. Holmes AA, Konig G, Ting V, et al. "Clinical evaluation of a novel system for monitoring surgical hemoglobin loss." Anesth Analg. 2014;119(3):588–94. doi:10.1213/ANE.0000000000000181

11. Vesely BD, Kipp J, Leffler L, et al. "Accuracy of estimated blood loss on common operating room items among medical professionals." J Am Podiatr Med Assoc. 2025;115(3):23–011. doi:10.7547/23-011

12. Freitas PS, Silveira RC, Clark AM, Galvão CM. "Surgical count process for prevention of retained surgical items: an integrative review." J Clin Nurs. 2016;25(13–14):1835–47. doi:10.1111/jocn.13216

13. Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. "Risk factors for retained instruments and sponges after surgery." N Engl J Med. 2003;348(3):229–35. doi:10.1056/NEJMsa021721

14. Kalovidouris A, Kehagias D, Moulopoulos L, et al. "Abdominal retained surgical sponges: CT appearance." Eur Radiol. 1999;9(7):1407–10. doi:10.1007/s003300050858

15. Statler JD, Miller DL, Dixon RG, et al. "Society of Interventional Radiology position statement: prevention of unintentionally retained foreign bodies during interventional radiology procedures." J Vasc Interv Radiol. 2011;22(11):1561–2. doi:10.1016/j.jvir.2011.07.011

16. Committee on Patient Safety and Quality Improvement. "Committee Opinion No. 464: Patient safety in the surgical environment." Obstet Gynecol. 2010;116(3):786–90. doi:10.1097/AOG.0b013e3181f69b22

17. American College of Surgeons. Revised Statement on the Prevention of Unintentionally Retained Surgical Items After Surgery. 2016; standardized counts, wound exploration, X-ray-detectable items and technology as indicated.

18. RF Surgical Systems. RF Assure/RFDetect product list, Rev C, pp 2–3: sterile and nonsterile lap-pad and 4 × 4 gauze SKUs, X-ray/RFD labeling and no-loop model.

19. Rupp CC, Kagarise MJ, Nelson SM, et al. "Effectiveness of a radiofrequency detection system as an adjunct to manual counting protocols for tracking surgical sponges: a prospective trial of 2,285 patients." J Am Coll Surg. 2012;215(4):524–33. doi:10.1016/j.jamcollsurg.2012.06.014