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Complications - GIST - distal gastrectomy according to Roux-Y

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

  1. Intraoperative Complications

    Intraoperative Tumor Injury:
    Should be strictly avoided, as tumor rupture is associated with a very high risk of peritoneal dissemination.

    Injury to Vessels
    Therapy: Suturing

    Injury to Bile Ducts
    Therapy: Suturing, if necessary, T-drainage

    Injury to the Pancreas
    Therapy: Suturing and extensive drainage

    Injury to the Spleen
    Therapy: Coagulation using Argon beam, fleece-supported tissue adhesion e.g. with TachoSil® (see Medical Equipment tab), last resort: Splenectomy

  2. Postoperative Complications

    Early Insufficiency of the Gastroenterostomy

    • usually on the 3rd – 4th postoperative day
    • Detection by endoscopy; radiological detection using water-soluble contrast medium has only a sensitivity of 50%
    • Revision requirement: with early intervention and favorable tissue conditions, direct closure by oversewing may still be possible, otherwise re-establishment of the anastomosis is necessary.

    Early Insufficiency of the Duodenal Stump

    • surgical revision with oversewing
    • if oversewing is technically not possible: external drainage of the duodenal stump via a strong Foley catheter

    Late Insufficiency of the Duodenal Stump

    • with good external drainage (e.g., CT-guided insertion) conservative management is possible; the resulting duodenal fistula can be anastomosed secondarily with an excluded jejunal loop

    Insufficiency of the Jejunojejunostomy

    • generally requires revision

    Intragastric Rebleeding

    • primary endoscopic hemostasis, if unsuccessful indication for surgical revision
    • Reopening of the stomach by transverse incision about 4-5 cm proximal to the anastomosis and targeted suturing of the bleeding source; reclosure also in a transverse direction.

    Extraluminal Rebleeding

    • depending on the intensity of bleeding, surgical revision
    • primarily due to lymphadenectomy or insufficient ligation of larger vessels
    • Bleeding source spleen: local hemostasis with spleen preservation if possible; if splenectomy is required, gastrectomy must be performed.

    Intra-abdominal Hematomas/Abscesses

    • ultrasound or CT-guided puncture and drainage
    • often associated with a suture insufficiency

    Pancreatitis

    • usually edematous pancreatitis with a good prognosis; fasting, conservative-medical treatment
    • hemorrhagic-necrotizing pancreatitis often due to intraoperative pancreatic injury; intensive care-interdisciplinary treatment, also surgical necrosectomy/lavage; high mortality!

    Passage Disorders of the Gastrojejunostomy

    • Causes: anastomotic edema, hematoma, or residual gastric atony
    • Remission expected within 10-14 days
    • surgical revision very rarely indicated

    Wound Healing Disorders

    • Treatment: wound opening, wound toilet, secondary wound healing, abdominal wall sealing

    Incomplete Resections (R1 or 2) If possible, re-exploration with the aim of complete re-resection.

    Recurrence After resection of High-risk GIST either a locoregional recurrence or distant metastases (primarily intrahepatic) develop within the first 24 months.

    Secondary Resistance The number of patients developing secondary resistance under ongoing TKI therapy is increasing.