Anaphylactic Reaction
- Circulatory stabilization
- Pharmacological therapy with vasoactive substances, antihistamines, and glucocorticoids
Bleeding
- From small vessels: Electrocoagulation or clips
- Arterial vessel leaks: Direct suture with Prolene® 5-0 or 6-0
- Due to the risk of injury to bile duct structures and further vascular injuries, bleeding in the hepatic hilum should not be blindly punctured, instead successive dissection and targeted management.
Transection of the proper hepatic artery or one of its main branches
- Consequences are unpredictable and can range up to lobe necrosis.
- Therefore, reconstruction of the main artery is mandatory, possibly as a saphenous vein interposition.
Injury to the major hepatic veins and/or the vena cava
- Can lead to air embolism or massive bleeding!
- Tangential clamping with oversewing
- In severe cases, manual compression and temporary occlusion of the inferior vena cava caudal and possibly also cranial to the liver after opening the diaphragm (suprahepatic clamping).
Prophylaxis of intraoperative bleeding
- Adequate access with sufficient exposure
- Generous mobilization of the liver
- Possibly intraoperative ultrasound with visualization of vascular structures
- Avoidance of overfilling the venous system (low CVP)
Bile leaks
- Management with clips or suture
Transection/Injury of the common bile duct
- Direct anastomosis possibly over T-drainage or creation of a biliodigestive anastomosis
Air embolism
- Is favored by a low or even negative CVP.
- Avoid further air entry by detecting, clamping, or oversewing the entry site, immediate PEEP ventilation.
Pneumothorax
- Can occur with findings near the diaphragm → intraoperative thoracic drainage.
Hollow organ injuries
- In previously operated patients, especially after cholecystectomy/procedures on the stomach, or due to massive adhesions in the pericystic area, adhesiolysis is necessary. Hollow organs may be injured in the process and must be appropriately managed/oversewn.