- Bleedings from the mesentery and hematoma formation in the mesentery. Here, the bleeding must be controlled with a further deep puncture. Subsequently, careful attention must be paid to whether the bowel ends to be anastomosed are still adequately perfused; if necessary, a re-resection must be performed.
- A massive contamination due to stool leakage should be avoided as much as possible. For this, soft bowel clamps can be placed on the bowel ends, and a moist drape should be used.
- Bleedings from the staple line can be oversewn with a continuous suture or single button sutures.
- In case of thread breakage during anastomosis, the suture should either be reapplied or a new thread placed and knotted.
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Intraoperative Complications
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Postoperative Complications
- Extremely rare is the anastomotic insufficiency in small bowel anastomoses, as these generally heal excellently. Prevention consists of using a subtle technique and ensuring that the anastomosis is excellently perfused and tight. An insufficiency due to technical errors typically becomes apparent around the 2nd – 3rd day, in healing disorders around the 5th – 7th day. Noticeable here are a passage disorder/ileus and high inflammatory parameters in the laboratory as well as septic temperatures and, of course, a clinically detectable defensive tension and peritonism. Ultimately, an immediate relaparotomy must be performed here, and the insufficiency managed with the temporary creation of a stoma. Only in exceptional cases should oversewing of the anastomosis or reanastomosis be performed. In the latter procedures, the prospects for healing are generally low and the risk of renewed insufficiency is considerable!
- As further complications, postoperative bleedings or infections intra-abdominally or in the wound area can occur. These are to be managed by appropriate drainages or, in the case of postoperative bleedings, by immediate relaparotomy. They should be recognized by monitoring circulatory parameters and through laboratory controls!