Typical risk factors for intraoperative injuries are:
- Obesity
- Altered anatomy due to previous surgeries, inflammations, and tumors
- Emergency interventions
Bowel injury 1-3%, adhesiolysis increases the risk to 3.8 – 13.6%
Possible injury patterns:
- Superficial serosal injuries
- Transmural lesions of the intestinal wall
- Thermal damage to the intestinal wall
- Mesenteric tears with subsequent ischemia of the dependent bowel segment
Treatment:
- Smaller lesions are sutured.
- Larger defects with poorly defined edges are conservatively excised and sutured, or a bowel wall resection with anastomosis is performed.
- Serosal defects should be generously re-serosed.
Pancreatic injury
In case of bleeding
- Electrocoagulation; hemostatic patches; compression and patience
In case of parenchymal injuries, it is advisable to place a drain to allow secretion drainage in the event of a pancreatic fistula.
Ureteral injury
Prevention by:
- Preservation of the Gerota's fascia
Vascular injury/bleeding
Risk constellation with tumor growth exceeding boundaries, inflammation, previous surgeries, or post-radiation status.
Bleeding usually occurs during preparation in the area of the right colonic flexure. In 90% of cases, the right colic vein does not directly drain into the superior mesenteric vein but forms a venous trunk with the right gastroepiploic vein, which may also include the middle colic vein and only then drains into the mesenteric vein. Inadequate exposure or improper traction on the mesentery can lead to central avulsion of this vein from this venous trunk.
Treatment: No indiscriminate attempts at ligation but controlled vascular suturing or initially sustained compression.
In case of another cause, recognition and localization of the bleeding source, primary bleeding control through compression or clamping, informing anesthesia, and providing blood products, if necessary, involving a vascular surgeon and preparing a vascular sieve, creating anatomical overview, repairing the vascular defect.