Gastrointestinal surgery is the most commonly performed surgery in abdominal surgery. Most gastrointestinal surgical diseases are benign except for malignant tumors. Even for malignant tumors of the gastrointestinal tract, most of them can be expected to survive for a long time if they are detected early and treated at an early stage. Therefore, a perfect and high quality gastrointestinal surgery is not a demanding requirement for patients; it should also be the duty of the surgeon.
However, what exactly is a perfect, high-quality gastrointestinal surgery? Simply put, it means that the surgery is completed in a standardized manner without recent and long-term surgical complications under the premise of strictly mastering the indications for surgery. And what are the complications of gastrointestinal surgery? What are the main symptoms?
Complications of gastrointestinal surgery are often divided into intraoperative and postoperative complications, and postoperative complications are often divided into two categories: those occurring in the early postoperative period, often related to pathological anatomy and surgical accidents; and long-term sequelae caused by postoperative anatomical and physiological changes and metabolic disorders. Due to the use and development of laparoscopy, there are also some complications specific to laparoscopic surgery. The following is a brief description of the common postoperative complications of gastrointestinal surgery.
I. Common complications during surgery
1.Anesthesia accident, cardiovascular accident
Due to the abnormal cardiopulmonary function of patients, during the surgery, the surgical stress causes the increase of blood pressure, heart rate and arrhythmia; the decrease of blood PO2 partial pressure and the increase of PCO2 partial pressure; in serious cases, the failure of cardiopulmonary function and cerebrovascular accidents, and even life-threatening.
Common preventive measures are.
(1) Preoperative cardiopulmonary function estimation.
(2) Preoperative fasting for more than 6 hours or emptying of stomach contents to prevent aspiration.
(3) General anesthesia is preferred to facilitate relaxation of surgery and intraoperative monitoring.
(2) Intraoperative hemorrhage, hemorrhagic shock, and death in severe cases
Surgical bleeding is the most common complication during surgery. Due to the operator’s lack of familiarity with the anatomical structure, anatomical variation and tumor infiltration and invasion, vascular injury is caused, and common large vessel injuries include: abdominal artery, mesenteric vessels, splenic artery and vein, portal vein, presacral vein, iliac vessels, mesentery and other important vessel injuries.
3, abdominal organ damage
Improper operation or anatomical variation during the operation, as well as adhesions, infiltrations, position changes or even fistulas in the cavity due to the involvement of tissues adjacent to the lesion.
For example, sinusoidal cancer invades the hepatoduodenal ligament and damages the common bile duct or the common hepatic artery during dissection; the middle colonic artery is damaged during gastrectomy, or even the three major pieces of the hepatoduodenal ligament (common hepatic duct, intrinsic hepatic artery and hepatic portal vein) are transected, or the ileum and stomach are anastomosed; the ureter is damaged during rectal cancer surgery; the spleen is damaged during gastrectomy, etc.
Common visceral injuries in gastrointestinal surgery include spleen injury, pancreatic injury, ureteral injury (the incidence rate of transabdominal perineal rectal cancer radical surgery is about 1%-2%), bladder and urethra injury (the incidence rate of transabdominal perineal rectal cancer radical surgery is about 3%-5%), etc.
Early complications after surgery
1. Bleeding
Postoperative intra-abdominal bleeding, gastrointestinal bleeding or anastomotic bleeding, requiring a second operation (incidence of about 1 to 2%). Bleeding that occurs within 24 days after surgery is mostly due to inaccurate intraoperative hemostasis; bleeding that occurs 4-6 days after surgery is often caused by necrosis and detachment of the anastomotic mucosa, and heavy bleeding that occurs 10-20 days after surgery is caused by infection at the anastomotic suture and corrosion of the blood vessels by submucosal abscess.
2.Obstruction
The common ones are input collaterals, output collaterals obstruction, stricture intestinal obstruction, and postoperative adhesive intestinal obstruction. The mechanisms of the causes are different, and the clinical symptoms appear differently. The common symptoms are abdominal distension, abdominal pain, vomiting, vomiting, etc.
3.Postoperative stump and anastomotic fistula
It often occurs about one week after surgery. The causes are related to improper suture technique, excessive anastomotic tension, and insufficient blood supply to the tissue, and are more likely to occur in patients with anemia, edema, and hypoproteinemia. The main manifestations are high fever, rapid pulse, abdominal pain and manifestations of diffuse peritonitis.
4.Hepatobiliary and pancreatic complications
Injury to the common bile duct, resulting in biliary peritonitis, postoperative bile duct stricture, jaundice, liver failure, and injury to the pancreas, resulting in pancreatic fistula.
5, Incisional fluid accumulation, hematoma, dehiscence, infection causing delayed healing.
6.Lung infection
Due to surgical anesthesia, the respiratory center and cough reflex center are inhibited, while the anesthetic drugs cause increased respiratory secretions and weakened cilia movement, combined with postoperative incision pain, fear of deep breathing and coughing, as well as the oral microenvironment, postoperative immunity decline, anesthetic intubation, indwelling gastric tube, etc. can increase the rate of lung infection.
7, postoperative bowel habits change (diarrhea, constipation, fecal incontinence, etc.).
Third, long-term postoperative sequelae
1.Postoperative dumping syndrome
The absence of anatomical structures controlling gastric emptying and the oversized gastrointestinal anastomosis lead to a series of syndromes of excessive gastric emptying. It can be divided into two types: early dumping syndrome patients may experience palpitations, tachycardia, sweating, weakness, pallor and other transient hypovolemic manifestations, as well as vomiting, vomiting, abdominal pain, diarrhea and other symptoms.
Patients with advanced dumping syndrome then show hypoglycemic symptoms such as dizziness, pallor, cold sweat, weak pulse and even syncope.
2.Alkaline reflux gastritis (Billroth II type is more common)
Occurs months to years after surgery, due to the inflow of alkaline bile, pancreatic juice and intestinal fluid into the stomach, which destroys the mucosa and leads to changes such as congestion, edema and erosion of the gastric mucosa. The triad of symptoms such as upheaval or burning pain behind the sternum, vomiting bile-like fluid and weight loss appear.
3. Complications of enterostomy port
Mucositis, peripheral dermatitis, stricture, intestinal prolapse, hernia formation, or intestinal necrosis and retraction are common.
4. Pelvic nerve injury
It leads to postoperative urination and sexual dysfunction (the incidence of transabdominal perineal rectal cancer radical surgery is about 25-100%).
5.Anastomotic ulcer (incidence about 2-3%) and residual gastric cancer
Residual gastric cancer generally occurs in more than 5 years, with an incidence of about 2%, often occurring in 20-25 years.
6.Weight loss, malnutrition, anemia
Due to total gastrectomy, enterostomy, large small intestine resection, liver, pancreatic resection and other digestive organs removal, it leads to the decrease of digestive function, intestinal dysfunction, and the impairment of nutrient absorption and anabolism.
IV. Postoperative complications specific to laparoscopic surgery
1.Complications of puncture
2.Complications related to pneumoperitoneum
3.Complications related to energy instruments
The success of the surgical operation does not mean that the operation has achieved its therapeutic purpose and the patient can recover successfully. The pejorative term “successful surgery, failed treatment” encompasses the failure of perioperative management and the failure of treatment to achieve the goal.
No matter complex surgery or simple surgery, the importance of preoperative, intraoperative and postoperative perioperative treatment as a whole should be achieved, only the degree of difficulty and complexity are different and the requirements are different.
If gastrointestinal tumor is not understood whether the patient has coagulation disorder before surgery, complications such as constant blood leakage and intra-abdominal hematoma and infection may occur during and after surgery. The absence of good postoperative drainage and reasonable antibacterial treatment can cause complications such as incisional infection, peritonitis, and pancreatic fistula.
If we can have a comprehensive understanding of each case of gastrointestinal surgery, select carefully, operate meticulously and handle properly, we can further reduce the occurrence of postoperative complications.