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Complications - Gastrectomy, subtotal, robotically assisted

robotics
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    Injury to Vessels
    Therapy: Suturing, vascular surgical reconstruction

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

    Injury to Pancreas
    Therapy: Suturing and extensive drainage

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

    Injury to Pleura/Diaphragm
    Therapy: Suturing, insertion of a chest drain

  2. Postoperative Complications

    Early Insufficiency of the Gastrojejunostomy

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

    Duodenal Stump Insufficiency <3%

    Therapy: In most cases of early insufficiency, surgical revision is indicated (oversewing, creation of a duodenojejunostomy, partial duodenopancreatectomy). Adequate drainage must always be ensured.

    Insufficiency of the Jejunojejunostomy rare (<1%)

    Therapy: usually surgical revision.

    Intraluminal Hemorrhage

    • Primary endoscopic hemostasis, if unsuccessful, indication for surgical revision.

    Extraluminal Hemorrhage

    • Depending on the intensity of bleeding, surgical revision
    • Bleeding source spleen: local hemostasis with spleen preservation if possible; last resort splenectomy
    • Beware of 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, lymph fistulas usually cease spontaneously.
    • In individual cases, temporary parenteral nutrition may be necessary.

    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; Beware: 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

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