Complications - Sigmoidectomy, laparoscopic - general and visceral surgery
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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.
- 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.