Complications - Sigmoidectomy, laparoscopic - general and visceral surgery
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Intraoperative complications
Anastomotic failure:
If the water-bubble test is positive and the anastomotic failure is small and readily accessible, it may be managed by oversewing it with a few stitches. In such a case, construction of a protective ileostomy should be considered. In case of doubt, construct a new anastomosis.
Organ injury:
- Splenic injury: Coagulate with bipolar electrocautery, ultrasound scissors, apply hemostatic or fibrin glue, if needed.
- Pancreatic injury: In case of bleeding proceed as in splenic injury. Here, it may be advisable to place an Easy-Flow drain to evacuate any secretions of a pancreatic fistula.
- Bowel injury: With sufficient expertise the lesion may be oversewn laparoscopically.
- Thermal injury by bipolar or ultrasound scissors, especially at the splenic flexure
- Vascular injury: Usually, small bleeding may be managed by bipolar electrocautery or ultrasound scissors, and clipping if necessary.
Immediate laparotomy is indicated in case of great vessel damage (e.g., aorta, vena cava)
- Ureter injury: In case of superficial injury laparoscopic oversewing may be attempted. Otherwise, a small laparotomy in direct projection of the lesion is recommended to allow manual suture of the ureter under direct view. In all cases ureteral stenting is indicated.
- Vaginal injury: Accidental trapping of the vagina when closing the stapler may result in rectovaginal fistulas.
In general, laparotomy is indicated whenever the laparoscopic view of the anatomy seen is inadequate.
Postoperative complications
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