- Bleeding from the mesentery and hematoma formation in the mesentery. Here, stop the bleeder with a deep suture ligation. Then carefully check the ends to be joined for adequate perfusion; if necessary, additional resection may be required.
- Avoid, as much as possible, massive contamination through stool spillage. To this end, close off the bowel ends with non-crushing clamps and drape the field with moist towels.
- Suture line bleeding may be stopped with a running suture or interrupted sutures.
- If the suture material fails while fashioning the anastomosis, the suture should either be redone, or a new suture placed and tied with the end of the failed first suture.
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Intraoperative complications
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Postoperative complications
- Anastomotic failure in small bowel anastomoses is extremely rare, since these usually heal exceptionally well. Prevention relies subtle technique and ensuring that the anastomosis is well perfused and gas- and liquid-proof. Suture line failure arising from technical mistakes typically manifests around postoperative day 2 to 3, and around day 5 to 7 when attributable to impaired wound healing. Characteristic here are impaired transit/ileus and significantly elevated markers of inflammation, as well as septic temperatures and, naturally, clinically detectable guarding and peritonism. These cases ultimately mandate urgent revision surgery, and the anastomotic failure must be controlled with a temporary stoma. Only in exceptional cases should the anastomosis be oversewn or refashioned. The healing prognosis of the latter is typically low, while the risk of renewed anastomotic failure is high.
- Other complications may include secondary bleeding and intraabdominal or wound infection. These can be controlled by appropriate drainage or, in the case of secondary bleeding, by immediate relaparotomy. These complications can be detected by monitoring the cardiovascular and lab parameters!