Anastomotic Insufficiency:
If the water test is positive, in the case of a small and easily accessible insufficiency, an oversewing can be attempted. In this case, the creation of a protective ileostomy should be considered. In case of doubt, the re-establishment of the anastomosis should be performed.
Organ Injury:
- Injury to the Spleen: Coagulation with bipolar current, ultrasonic scissors, possibly applying a hemostatic agent or fibrin glue. A laparotomy is only necessary in exceptional cases.
- Injury to the Pancreas: In case of bleeding, proceed similarly to spleen injuries. Here, the placement of an Easy-Flow drainage is recommended to drain secretions in case of a pancreatic fistula.
- Injuries to the Intestine: With appropriate expertise, laparoscopic oversewing is possible.
- Thermal damage using bipolar scissors or ultrasonic dissector, especially in the area of the left flexure.
- Vascular Injury: Bleeding from smaller vessels can usually be controlled using bipolar current or ultrasonic scissors and possibly by clipping.
Injuries to large vessels (e.g., aorta, vena cava) require immediate laparotomy. - Injury to the Ureter: In case of superficial injuries, laparoscopic oversewing can be attempted; otherwise, a small laparotomy directly over the injury site is recommended to suture the ureter under direct vision. In any case, the insertion of a ureteral stent is indicated.
- Injury to the Vagina: Accidental entrapment of the vagina during the use of the stapling device can lead to the formation of rectovaginal fistulas.
It should be noted that in situations without sufficient anatomical overview, a laparotomy is indicated.