腹腔镜手术并发症的常见问题【视频+英文讲义】

What are the complications of laparoscopic surgery?

Like any surgery laparoscopy has the potential risk of anaesthesia and operation. Although laparoscopy causes less tissue injury then its open counterpart but it is wrong to say that it is totally risk free operation. Complications of laparoscopy may be categorized according to the various phases of the operation. Problems related to induction of the pneumoperitoneum and insertion of the laparoscope includes cardiac arrhythmias, perforation of a hollow viscus, and puncture of a solid organ, bleeding, and subcutaneous emphysema. In most reported series, complications of laparoscopic surgeries are minor and occur with a frequency of 1-5%, and the mortality rate is approximately 0.05%.

The common complications are:

• Complications of anaesthesia like cardiac arrhythmia, and respiratory complications.

• Transient high fever.

• Abdominal wall ecchymosis.

• Pneumonia and bronchitis.

• Bleeding due to injury of unrecognised blood vessels.

• Injury to internal solid organs.

• Perforation of hollow viscus

• Injury of major blood vessels.

• Thromboembolism.

• Infection.

• Hernia.

• Adhesion formation.

  
  

All these complication are not specific to laparoscopy. These complications are more frequent in open surgery than laparoscopy.

What is the most common complication after laparoscopic surgery?

Infection is the most common complication of any surgical procedure. In laparoscopic surgery rate of infection is very less than open surgery but many statistical studies shows that infection is still the most common complication after laparoscopic surgery. This complication is not related to the laparoscopic technique itself but depends on the sterilization and theatre environment of the hospital. The Injury to the bowel is the second most common cause of morbidity and mortality after laparoscopic surgery.

What are the complications specific to laparoscopic technique?

The Injury to bowel and blood vessels is specially related to the technique of laparoscopic surgery.  There is a small risk of complications that include, injury to the abdominal organs, intestines, urinary bladder or blood vessels. If the surgeon is not experienced than he can perforate an innocent bowel with the long pointed instruments of laparoscopic surgery. If complication is severe an additional operation may be required with a larger incision to either stop bleeding or repair an injury that cannot be fixed by laparoscopy. In case of infection and other mild complication short course of appropriate antibiotic is sufficient to overcome the problem. In experienced hands, complications may occur but are not frequent. Patient safety should be surgeon's strongest concern.

When should I suspect a complication?

If patient have fever, chills, vomiting, are unable to urinate, developed increasing redness at an incision site, or if pain is worsening, distension of abdomen or any discharge from the port site, patient should contact their surgeon promptly.

What is weeping peritoneum?

It is a rare complication of minimally invasive surgery due to irritation of peritoneum. Carbon dioxide is known to be a peritoneal irritant which produces congestion of the vessels in patients undergoing laparoscopy. An exaggerated response to the irritant may manifest symptoms of weeping peritoneum which is pyrexia, Increased heart rate and respiration cramp abdomen, vomiting and if not treated sometimes leads to severe peritonitis.

How can hernia develop through the tiny hole made during laparoscopy?

Incisional bowel herniation is a complication of operative laparoscopy. Herniations occur through ports 10 mm in size at both umbilical and extraumbilical sites if not closed properly after operation. Surgeons should recognize the importance of closing fascia at these larger port sites and should maintain a high degree of suspicion in any patient who has a slow recovery with intermittent nausea and vomiting after an operative procedure. The underlying fascia and peritoneum should be closed not only when using trocars of 10mm and larger as previously suggested but also when extensive manipulation is performed through a 5mm trocar port, causing extension of the incision.

What are the contraindications of laparoscopic surgery?

Contraindications for laparoscopy are relative and include the uncooperative patient, uncorrectable coagulation defects, severe congestive heart failure, respiratory insufficiency, suspected acute, diffuse peritonitis, and the presence of distended bowel. If tense ascites is present, large volume paracentesis can be performed as the preliminary step in the laparoscopy. Previous laparotomy incisions may necessitate alteration of the usual trocar insertion site, or may represent a contraindication to the procedure. Most surgeons would not recommend laparoscopy in those with pre-existing disease conditions.  Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy.  Laparoscopy may also be more difficult in patients who have had previous abdominal surgery.  The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum.  Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.

What preoperative precaution patient should take?

• Patient should not eat or drink for six to eight hours before the procedure.

• Report of all the investigations should be present eg; blood, urine or X-ray testing may be required before your operative procedure.

• Patient should have shower the evening before or the day of your operation. Cleaning of umbilicus ("belly button") with antiseptic soap, water, and a Q-tip is important.

• Patient should report to the hospital at the correct time, which is usually 4-6 hours earlier than your scheduled surgery.

• If patient take any medication on a daily basis, discuss this with your surgeon as you may need to take some or all of the medication on the day of surgery with a sip of water. If you take aspirin, blood thinners or arthritis medication, discuss this with your surgeon.

  
  

What preoperative precaution patient should take in selecting a surgeon?

The outcome of any laparoscopic procedure greatly depends on the experience of the surgeon.  In a study from Los Angeles, the outcome of cases operated by generalists (285) were compared with those performed by specialised laparoscopic surgeons (n = 232).  10 abscesses occurred post operatively (2.4%) in the group of patients whose operation was done by general surgical services as compared to one case (0.025%) in the group of patients whose operation was performed by expert. Laparoscopy by expert (using skilled dissection, use of retrieval bag, proper ligation of stump and thorough peritoneal toilet) decreases complication rate. In experienced hands, complications may occur but are not frequent. Patient safety should be your surgeon's strongest concern.