Complications - Open surgical gastrectomy

Injury to Vessels
Therapy: Suturing, vascular surgical reconstruction

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

Injury to the Pancreas
Therapy: Suturing and extensive drainage

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

Insufficiency of the Esophagojejunostomy

• Detection via endoscopy; radiological detection using water-soluble contrast medium has only a sensitivity of 50%!
• With early intervention and favorable tissue conditions, direct closure by oversewing is still possible in exceptional cases.
• for small insufficiency: covered stent (requirement: bile-resistant coating, e.g., silicone)
• for larger defects: endoscopic vacuum therapy (EsoSponge®)
• for large, otherwise uncontrollable defect: discontinuity resection with cervical mucus fistula

Insufficiency of the Duodenal Stump

• surgical revision with oversewing
• if oversewing is technically not possible: duodenal stump drainage
• preferably conservative approach; a resulting duodenal fistula can be secondarily diverted with a Roux-en-Y excluded jejunal loop

Insufficiency of the Jejunojejunostomy

• usually requires revision

Intraluminal Bleeding

• primary endoscopic hemostasis, if unsuccessful indication for surgical revision

Extraluminal Bleeding

• depending on the intensity of bleeding, surgical revision
• Bleeding source spleen: local hemostasis preferably with spleen preservation; last resort splenectomy
• Caution: infection-related erosion bleeding in duodenal stump insufficiency

Intra-abdominal Hematomas/Abscesses

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

Lymph Fistulas

• possible after systematic (D2-) or extended (D3-) lymphadenectomy, rarely also chylous ascites
• After removal of the inserted drains, the lymph fistulas usually cease spontaneously.
• In individual cases, temporary parenteral nutrition may be necessary.

Pancreatitis

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

Passage Disorders of the Esophagojejunostomy

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

Wound Healing Disorders

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