- Massive bleeding due to injury of major vessels
- By compression using a gauze swab, the situation can usually be controlled to the extent that, under continuous compression, the transition to thoracotomy can be managed in a controlled manner without excessive blood loss, and the anesthesia team can be informed, additional instruments prepared, and, if necessary, appropriate assistance organized. Blind clamping and suturing attempts generally exacerbate the damage.
- Parenchymal lesions of the lung during mobilization or in the area of staple lines
- An attempt at suturing is often futile in vulnerable lung tissue or emphysematous lung. Here, the use of staple line reinforcement or a sealing matrix is helpful.
- In individual cases, the surgeon must decide, based on information from anesthesia, about the fistula volume, whether conservative therapy with chest drainage is also justifiable.
- Injury to the contralateral pleura
- An unnoticed opening of the contralateral mediastinal pleura can lead to tension pneumothorax. It is important to recognize the situation and either open the pleura widely or insert a chest drain on the opposite side.
- Injury to the tracheal wall, main bronchi, or other segmental bronchi
- Injury to the vagus nerve, phrenic nerve, and recurrent laryngeal nerve
- Injury to the esophagus
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Intraoperative Complications
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Postoperative Complications
- Cardiac arrhythmia (10-15%)
- Persistent air fistula (from the 8th postoperative day, approx. 8-15%)
- A revision surgery due to a parenchymal fistula is very rarely required. Conservative therapy (with patience, suction release attempt, or chemical pleurodesis) is often sufficient.
- Postoperative pleural empyema (0.1-2%)
- The most common cause is the persistent air fistula with contamination of the pleural cavity in the presence of a pre-existing immune deficiency.
- The therapy initially consists of adequate drainage and antibiotic therapy. An operative revision is often required in the case of a persistent bronchopleural fistula.
- The most important measures, in addition to the rapid initiation of therapy with broad-spectrum antibiotics, are bronchial toilet and bronchoscopic material collection (microbiology) as well as intensive physiotherapy.
- Hemothorax (with necessary transfusion or re-operation 1-4%)
- Immediate operative revision with 1L of bloody secretion in the first hour after surgery or persistent output of 200-400ml/h in the first 5 hours after surgery.
- Chylothorax (0.5-1%)
- Initially conservative therapy using MCT diet or parenteral nutrition. If secretion persists for over 14 days, a radiological intervention or surgery is indicated.
- Vocal cord paralysis (0-1%)
- Speech therapy and ENT medical co-management.
- Nerve lesions due to positioning damage