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Complications - Segmental jejunal resection with side-to-side anastomosis

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative complications

    • Bleeding from the mesentery and mesnteric hematoma formation. Here, the bleeding must be managed by additional deep suture ligation. Care must then be taken to ensure that the blood supply in the intestinal ends to be anastomosed is still adequate; if necessary, additional bowel must be resected.
    • Massive fecal contamination should be avoided as best as possible. To this end, soft intestinal clamps may be placed at the ends of the bowel and the surroundings protected with with moist towels.
    • Bleeding from the staple line can be stopped with a running suture or interrupted sutures. 
    • If the suture ruptures during anastomosis, either repeat the suture anew or continue with a new suture then tied to the ruptured suture.

  2. Postoperative complications

    • Anastomotic failure in anastomoses of the small intestine is extremely rare, since these usually heal exceptionally well. Such failure may be prevented by employing painstaking surgical technique and ensuring that the anastomosis has excellent blood supply and does not leak. Technically related anastomotic failure usually becomes manifest on postoperative 2 or 3, and in case of healing problems on postoperative day 5–7. The most conspicuous features here are impaired intestinal passage/ileus and lab panels with elevated levels of the inflammation parameters, septic temperatures and, of course, guarding and peritonism on clinical examination. This requires revision surgery without delay, and the anastomotic failure is managed with a stoma. Oversewing the anastomosis or reanastomosis should clearly be reserved for special cases. In the latter case, the chances of healing are usually low and the risks of renewed anastomotic failure considerable!
    • Other complications include postoperative bleeding and infections within the abdominal cavity or in the wound area. These can be controlled by appropriate drainage or, in the case of secondary bleeding, by immediate revision surgery. This should be detected by monitoring the cardiovascular parameters and by lab testing!