Complicaciones de la cirugía abdominal

  1. Domínguez Comesaña, E. 1
  2. Caínzos Fernández, M.A. 1
  3. Fernández Pérez, A. 1
  4. Bustamante Montalvo, M. 1
  1. 1 Servicio de Cirugía General. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela. A Coruña. España. Departamento de Cirugía. Universidad de Santiago de Compostela. Santiago de Compostela. A Coruña, España
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2020

Título del ejemplar: Enfermedades del aparato digestivo (X)Patología urgente y quirúrgica abdominal

Serie: 13

Número: 10

Páginas: 563-574

Tipo: Artículo

DOI: 10.1016/J.MED.2020.06.004 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Objetivos de desarrollo sostenible

Resumen

Deviations of the normal post-operatory process are the complications in abdominal surgery. The most used classification is the Clavien-Dindo; this classification takes into account clinical impact and therapeutic consequences (ranking in five degrees). Adhesions obstructions, ileum, postsurgical hemorrhages, suture dehiscence and reinterventions are reviewed. Clinical manifestations vary depending on type of complication, ranging from unspecific symptoms to multi organ failure and shock. Because some severe complications may present with very subtle manifestations, a high level of suspicion has to be maintained for the diagnosis. CT assessment is required for the most of intraabdominal complications. Endoscopic studies and arteriography may be necessary in post-surgical hemorrhages. Treatment varies according the complication. Therapeutic options include symptomatic and pharmacological treatment, non-surgical invasive procedures (endoscopic, percutaneous drainage, arteriography embolization) and urgent relaparotomy.

Referencias bibliográficas

  • Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystec-tomy. Surgery. 1992;111:518-26.
  • Dindo M, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
  • Leung TT, Dixon E, Gill M, Mador BD, Moultion KM, Kaplan GG, et al. Bowel obstruction following appendectomy: what is the true inciden-ce? Ann Surg. 2009;250:51-3.
  • Menzies D, Ellis H. Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl. 1990;72:60-3.
  • Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, et al. Postoperative adhesions: ten-year follow-up of 12,584 patients un-dergoing lower abdominal surgery. Dis Colon Rectum. 2001;44:822-30.
  • Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186:1-9.
  • Caínzos M, Rodríguez-Segade F, Martínez-Castro J, Prieto D, Becker MR, Aneiros F, et al. Intra-abdominal adhesions after open and laparos-copic cholecystectomy: an experimental study. J Laparoendosc Adv Surg Tech. 2006;16:108-12.
  • Seo GH, Choe EK, Park KJ, Chai YJ. Incidence of adhesive bowel obstruction after colon cancer surgery and its risk factors. Ann Surg. 2018;268:114-9.
  • Stommel MWJ, ten Broek RPG, Strik C, Slooter GD, Verhoef C, Grün-hagen DJ, et al. Multicenter observational study of adhesion formation after open-and laparoscopic surgery for colorectal cancer. Ann Surg. 2018;267:743-8.
  • Ten Broek RP, Kok-Krant N, Bakkum EA, Bleichrodt RP, van Goor H. Different surgical techniques to reduce post-operative adhesion forma-tion: a systematic review and meta-analysis. Hum Reprod Update. 2013; 19:12-25.
  • Gero D, Gié O, Hübner M, Demartines N, Hahnloser D. Posto-perative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbecks Arch Surg. 2017;402:149-58.
  • Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015;34:367-76.
  • Traut U, Brügger L, Kunz R, Pauli-Magnus C, Haug K, Bucher H, et al. Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev Art. 2018;(1):CD004930.
  • Hübner M, Blanc C, Roulin D, Winiker M, Gander S, Demartines N. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg. 2015;261:648-53.
  • Gervaz P, Inan I, Perneger T, Schiffer E, Morel P. A prospective, rando-mized, single-blind comparison of laparoscopic versus open sigmoid co-lectomy for diverticulitis. Ann Surg. 2010;252:3-8.
  • Su’a Bu, Pollock TT, Lemanu DP, MacCormick AD, Connolly AB, Hill AG. Chewing gum and postoperative ileus in adults: A systematic litera-ture review and meta-analysis. Int J Surg. 2015;14:49-55.
  • Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339-51.
  • Schaible A, Schmidt T, Diener M, Hinz U, Sauer P, Wichmann D, et al. Intrathoracic anastomotic leakage following esophageal and cardial resec-tion: Definition and validation of a new severity grading classification. Chirurg. 2018;89:945-51.
  • Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Ad-ham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2017;161:584-91.
  • Shogan BD, An GC, Schardey HM, Matthews JB, Umanskiy K, Flesh-man JW, et al. Proceedings of the first international summit on intestinal anastomotic leak, Chicago, Illinois, October 4-5, 2012. Surg Infect (Lar-chmt). 2014;15(5):479-89.
  • Fumagalli U, Baiocchi GL, Celotti A, Parise P, Cossu A, Bonavina L, et al. Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks. World J Gas-troenterol. 2019;21;25:356-66.
  • Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018;24:2247-60.
  • Soreide K, Labori KJ. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review. Scand J Gastroenterol. 2016;51:1147-54.
  • Manta R, Caruso A, Cellini C, Sica M, Zullo A, Mirante VG, et al. En-doscopic management of patients with post-surgical leaks involving the gastrointestinal tract: A large case series. United European Gastroenterol J. 2016;4:770-7.
  • Blumetti J, Abcarian H. Management of low colorectal anasto-motic leak: Preserving the anastomosis. World J Gastrointest Surg. 2015;7:378-83.
  • Malleo G, Vollmer CM. Postpancreatectomy complications and management. Surg Clin North Am. 2016;96:1313-36.
  • Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an international Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20-5.
  • Malik AH, East JE, Buchanan GN, Kennedy RH. Endoscopic haemosta-sis of staple-line haemorrhage following colorectal resection. Colorectal Dis. 2008;10:616-8.
  • Jones S, May AK. Postoperative gastrointestinal hemorrhage. Surg Clin North Am. 2012;92:235-42.
  • Asari S, Matsumoto I, Toyama H, Yamnaguchi M, Okada T, Shinzeki M, et al. Recommendation of treatment strategy for postpancreatectomy he-morrhage: Lessons from a single-center experience in 35 patients. Pan-creatology. 2016;16:454-63.
  • Strik C, Stommel MW, Schipper LJ, van Goor H, Ten Broek RP. Risk factors for future repeat abdominal surgery. Langenbecks Arch Surg. 2016;401:829-37.
  • McQuarrie DG. Techniques and approaches that facilitate operation in the abdomen. En: Mcquarrie DG, Humphrey EW, Lee JT, editors. Reoperative general surgery. 2º ed. St Louis Missourie: Mosby-Year Booc Inc; 1997.
  • Baez S, Juárez-de la Torre JC, Navarro-Tovar F, Heredia-Montaño M, Quintero-Cabrera JE. Abdominal unplanned reoperations in the Service of General Surgery, University Hospital of Puebla. Gac Med Mex. 2016; 152:457-63.
  • Birkmeyer JD, Hamby LS. Birkmeyer CM, Decker MV, Karon NM, Dow RW. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg. 2001;136:405-11.
  • Unalp HR, Kamer E, Kar H, Peskersoy M, Ali Onal M. Urgent abdominal re-explorations. World J Emerg Surg. 2006;1:10.
  • Koirala R, Mehta N, Varma V, Kapoor S, Kumaran V, Nuindy S. Urgent redo-laparotomies: patterns and outcome-a single centre experience. In-dian J Surg. 2015;77:195-9.
  • Kazaure HS, Roman SA, Sosa JA. Association of postdischarge complica-tions with reoperation and mortality in general surgery. Arch Surg. 2012; 147:1000-7.
  • Aloia TA, Cooper A, Shi W, Vauthey JN, Lee JE. Reoperative surgery: a critical risk factor for complications inadequately captured by operative re-porting and coding of lysis of adhesions. J Am Coll Surg. 2014;219:143-50.
  • Carmichael JC, Mills S. Reoperation for small bowel obstruction— how critical Is the timing? Clin Colon Rectal Surg. 2006;19:181-7.
  • Gili-Ortiz E, González-Guerrero R, Béjar-Prado L, Ramírez-Ramírez G, López-Méndez J. Dehiscencia de la laparotomía y su impacto en la mortalidad, la estancia y los costes hospitalarios. Cir Esp. 2015;93:444-9.
Fuente de los datos: Dialnet