Complications of abdominal surgery power point

Common complications in abdominal surgery

1. Complications of Abdominal Surgery Kirengo t. (ST3), YGC General surgery DEPT.

2. OBJECTIVE Competency in the assessment and management of common complications of GI surgery

3. Introduction Complications post abdominal surgery is a broad subject We shall focus on common surgeries and their complications Risk factors Classification: Early vs late Severity: Clavien-Dindo classification Local vs systemic

4. Clavien-Dindo (2004) classification

5. Clavien-Dindo classification:

6. Risk Factors Emergency vs Elective Prior abdominal/ pelvic surgery – adhesions Complexity of surgery Patient factors: frailty, age, nutrition, ASA grade, comorbidities Surgeon factors: time, grade

7. Infection Surgical wound site: superficial vs deep Presentation: pain, erythema, sepsis- fever, tachy Ix : Pus swab, blood cultures, FBC, CRP Imaging: CT/ USS Abdominal cavity infection: Abscess, peritonitis Consider causes: anastomotic leak, perforation Sepsis 6 Rx: need drainage, Abx

8. Bleeding/ Vascular injury Major vessels - aorta, IVC, iliacs vs Minor vessels - abdominal wall, omentum , mesentery Intra-op: pressure, electrocautery, transfixing with suture, clip Delayed presentation: abd wall pain, swelling, hematoma, visible bleeding, hemodynamic instability CCRISP: IV access, GS, IV fluids, transfusion Ix : CTAP/ angio May require return to theatre

9. Bowel Injury Laparoscopic port entry injury Dissection related: electrosurgical injury or trauma during dissection or manipulation Intra-op: oversaw, resection Missed injury: presentation 1-7 days post-op Continued abd pain, infection (fever, tachy ) Ix : CTAP- increasing free abd fluid, air Mx: Return to theatre

10. Urinary Tract Injuries Consider post – colorectal, hernia repair, appendicectomy or pelvic surgery Laparoscopic port entry injury – bladder (e.g. patients not voided bladder, not catheterized) Clinically: gas in urinary catheter bag, or blood Dissection related: bladder or ureters Presentation: early or later, AKI, retention, hematuria Management: simple catheterization to surgical urological repair Contact urology

11. Surgical Site Wound infection: erythema, wound drainage, or fever Cleaning, dressing, pus swab, antibiotics Wound dehiscence: ?bowel evisceration May need surgical repair Later: Incisional and port site hernias Repair if symptomatic

12. VTE(PE/DVT) Risks: Obese, Previous VTE, Hypercoag, Prolonged surgical time >3hrs, Elevated intra-abd pressure in laparoscopy, cancer, age >65y Risk reduction: Mechanical: TEDs, Flowtrons Chemoprophylaxis: Enoxaparin Presentation: Wells (Modified) criteria DVT: Limb swelling, pain, warmth PE: DIB, chest pain, tachy, cough Management: CCRISP: if unstable Ix: CTPA, duplex USS lower limb, ?D-dimer Treatment: anticoagulation

13. Bowel Obstruction Adhesions Post-op ileus: maybe normal <1wk Peritonitis/ infection Internal hernias: omental or mesenteric defects Ix : CT scan Approach: D/w responsible consultant, conservative rx , mobilization, escalation if no progress

14. Surgery specific complications: Anastomotic leak: 1-8% of resection primary anastomosis procedures Sign: large fluid/ air collections intra- abdo , pain, distention, sepsis Ix : CT, ?contrast oral/ rectal Bile duct injury: 1:300 cholecystectomies Sign: Jaundice, elevated bili , sepsis, distention, pain Ix : CT inc. fluid collection around subhepatic bed, LFTs Treatment: D/W responsible consultant IR drainage, surgery, ERCP

15. Other complications Nerve injury: Trendelenberg position- upper extremity nerve injury Lithotomy position- lower extremity nerve injury (common peroneal, sciatic, or femoral nerve) Subcutaneous emphysema: improper insufflation in laparotomy Pneumoperitoneum related effects: Hemodynamic: Changes: Increased systemic vascular resistance (SVR), arterial blood pressure (ABP), and cardiac filling pressures Complications: hypotension, hypertension, and arrhythmias pulmonary: Changes: increased intrathoracic pressure, reduced functional residual capacity (FRC), and increased airway pressures Complications: hypoxia, hypercarbia Other Conditions: AF, DM, MI, Stroke, HF, Endocrine (Thyroid, Addison)

16. “Normal” post-op issues: Pain Subcutaneous emphysema – disappears in a week Pneumoperitoneum – may last 1-3 weeks Postoperative ileus – 3-5 days post op Fluid collection – minimal fluid that should progressively reduce/ spontaneously resolve Consider previous surgeries/ findings when requesting & reviewing imaging E.g. CBD dilation post-lap chole

17. Summary:

18. QUESTIONS