8The prevention and management of perioperative complications
Section snippets
Bleeding
Intraoperatively, anatomical dissection of large and small vessels during lymphadenectomy in the thorax or abdomen is mandatory to prevent uncontrolled bleeding. Vessels should be securely closed with suture ligation or properly placed clips. Special care is necessary in T4 carcinomas or after neoadjuvant radiochemotherapy because the tissue layers can be difficult to dissect and vessel walls tend to be vulnerable.16, 17 Small branches of the aorta can cause a problem in patients with
Bleeding
Postoperative bleeding in the chest or the abdomen has to be detected as early as possible. Puncture and aspiration under ultrasonic guidance can prove bleeding as the reason for the fluid collection. In the case of continuing bleeding, the patient should undergo re-operation as soon as possible. It is more important to avoid shock and multiple transfusions than re-operation. In case of revisional surgery, blood has to be washed out completely and bleeding has to be stopped definitely. However,
Summary
Apart from oncological problems, complications after oesophagectomy are the main issues for successful treatment of oesophageal cancer. Due to the frequent presence of considerable risk factors in patients with AC and the invasiveness of the surgical procedure, perioperative complications cannot completely be avoided. Therefore all efforts must focus on exclusion of high-risk patients and prevention or early detection of complications and their consequent treatment. It has been shown that
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Cited by (41)
Endoscopic vacuum therapy for anastomotic leakage after esophagectomy: a retrospective analysis at a tertiary university center
2023, Surgery Open ScienceCitation Excerpt :The incidence of AL varies highly and is reported to up to 60%, however, the Esophagus Complications Consensus Group (ECCG) reported an incidence of 19% across 14 high-volume centres [4]. Consequences of AL are high morbidity and morality rates, a prolonged intensive care unit (ICU) and hospital stay, increased hospital costs and negative long-term outcomes such as long-time survival and quality of life [5–7]. Over the last two decades treatment of AL after esophagectomy has undergone an evolution.
Developing a toolbox for identifying when to engage senior surgeons in emergency general surgery: A multicenter cohort study
2021, International Journal of SurgeryCitation Excerpt :This may help explain why success with process-based interventions in elective surgery cannot simply be repeated in emergency surgery, a phenomenon seen in our patient safety program and others [6,23] A key difference between elective and emergency surgery is the time available for a thorough evaluation of patients for risk of possible adverse outcomes [24]. The preoperative stage is compressed in emergency general surgery, and the clinical judgment of an experienced surgeon is of great importance in making the treatment plan and detecting the patient's functional defects to minimize risk of operation-related and medical complications [25,26]. Therefore establishing a “green” pathway to have experienced surgeons handle the most life-threatening conditions would be important to drive improvement in emergency general surgery.
Systematic review of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer
2014, European Journal of Surgical OncologyCitation Excerpt :Some studies showed that risk factors for developing anastomotic leakage were ischemia, neoadjuvant therapy, comorbid conditions, splenectomy and pancreatectomy.32,33 It is also well established that inadequate vascularization and tension are major issues for leading to anastomotic leakage.34 Pulmonary complications are common after gastrectomy.
Omentoplasty in the prevention of anastomotic leakage after oesophagectomy: A meta-analysis
2014, European Journal of Surgical OncologyCitation Excerpt :With only a minor modification of surgical technique, omentoplasty may pose a cost-effective and pragmatic solution to the problem of anastomotic leakage post-oesophagogastomy. It is regarded that a cervical anastomosis of stomach to oesophagus is placed under greater tension and imparts greater risk of ischaemia to the gastric conduit than thoracic anastomosis.12 This may go some way to account for previous reports of higher leakage rates in cervical anastomoses.13,14