Complications Of Laparoscopic Surgery
As a rule, the difficulties in laparoscopic medical procedure will generally rely upon the level of intricacy of the surgery. Moreover, the experience of the specialist is an element that impacts the presence of confusions. These inconveniences can show up during a medical procedure or postoperatively. Ethicon Laparoscopic Trainer.
Laparoscopic Training simulation with Ethicon Laparoscopic Trainer is a prudent choice.
They might impact the difference in medical procedure to accomplish the underlying therapy. That the programming of another medical procedure to address the entanglement and, in the most pessimistic scenario, and with a base rate, morbidity.
Then again, there are risk factors in the patient that incline the presence of complexities in laparoscopic medical procedure, which will talk about later.
The most widely recognized wounds in laparoscopic medical procedure are vascular and digestive wounds. However, gallbladder and urethral wounds, hernias, and diseases, among others of lesser seriousness, likewise will quite often happen.
Bladder Injuries
It is another type of serious injury, although rare. A bladder puncture that goes unnoticed could cause serious injuries, especially in those cases that occur extra-peritoneally. If it detects, an immediate suture of the gap and the placement of a permanent catheter must carry out, for at least six days, under antibiotic protection. Otherwise, if the injury goes unnoticed, observes in the postoperative period; A new laparoscopic exploration recommends to visualize the bladder opening that communicates with the peritoneum and its suture.
Urethral Injuries
These injuries typical of laparoscopic surgery increased in frequency with the arrival of this approach. The basic principle in laparoscopic surgery adjacent to the urethral structures is the identification of its path before proceeding. They are more exposed during laparoscopic total hysterectomy procedures, pelvic inflammatory disease, and endometriosis. Likewise, there are factors that predispose to urethral complications, such as pelvic tumors, which alter the anatomy. The three most common places in order of frequency are:
- At the level of the infundibulum-pelvic,
- At the junction at the level of the uterine artery in the parametrium, and
- At its entrance to the bladder
The reported incidence of bladder and ureteral injuries is 0.03% to 0.13%, of which bladder injuries represent the most frequent, 2 to 3 times, compared to ureteral injuries. The most common types of urinary injuries are bladder perforation, followed by fistula, ureteral ligation, and ureteral cut. However, no difference reports with open gynecological surgery. The main symptoms that raise suspicion of bladder injury are vomiting, fever, abdominal pain or distension, chills, oliguria, urinary retention, anuria, or persistent dribbling of urine. For many reasons use of simulators is a prudent choice like Ethicon Laparoscopic Trainer.
Hernias
The appearance of intestinal hernia through wall defects is more frequent in cases of procedures that require multiple entries. The use of dilators that increase fascial damage or the extraction of large tumors. The Association of Gynecological Laparoscopists in a study of 4,385 laparoscopic procedures, collected 933 hernias, of which 80% presented despite fascial closure. Likewise, the study established that the risk is greater in extra-umbilical sites. And it increases with the use of 12-mm trocars (3.1%) compared to 10-mm trocars (0.23%), which is why the fascia closes at these incisions.
Note that the formation of postpneumoperitoneum hernias is infrequent and rare. In this regard, cases documents of patients treated with laparoscopy:
- Cholecystectomy,
- Fundoplication,
- Appendectomy, and
- Where a variable pneumoperitoneum pressure of 14 to 16 mm-hg uses during the procedure.
However, within a few days a hernia developed inguinal. Consequently, the cause of the development of postsurgical hernias is due to factors such as
- A preformed sac,
- The position during surgery,
- High pneumoperitoneum pressure and
- The use of anesthetic drugs
Need For Laparotomy
It is a change of surgical modality,
without previous programming, that goes from performing a laparoscopic surgery to a laparotomy, and whose unforeseen decision is because the first surgical procedure. Originally scheduled cannot do with:
- The smallest incisions,
- Typical of laparoscopy, and
- The condition found in the patient
- Required a larger incision to carry out the treatment successfully
Other complications
Infections are one of the rarest complications, accounting for approximately 0.1% of cases. Other infrequent complications are bruising and adhesion formation. In addition, neurological injuries can occur basically caused by poor positioning of the patient during surgery.
Laparoscopic Surgery (Risk Factors)
Patient comorbidity influencing complications of laparoscopic surgery (risk factors).
For assert that there are important risk factors that predispose the appearance of complications in laparoscopic surgery, which are typical of the patient’s condition before and after the intervention. Such as:
- Preoperative chronic anemia,
- Malnutrition,
- History of drug use,
- Smoking,
- Need for exploration of the biliary tract,
- Previous infection by staphylococcus aureus,
- Pneumonia, or
- Urinary tract infection in the postoperative period
For as the patient’s age increases, the number of associated pathologies increases, in addition to complications. Which is why advanced age representing a risk factor for mortality, intraoperative conversions to open cholecystectomy and intra or postoperative complications. This causes confusion and keeps the surgical staff alert in making decisions to obtain the best results.
For age also represents a risk factor for the appearance of complications in laparoscopy, with the population most vulnerable to these complications being children and the elderly. Laparoscopic cholecystectomy is one of the most common surgical procedures performed on older adults. Smoking, patients aged 75 years or older, and alcoholism are surgical risk factors related to the appearance of anesthetic complications, in geriatric patients, during video-laparoscopic cholecystectomy.
Advantages
Laparoscopic surgery, due to its advantages, has become today the path of choice for the exploration, diagnosis, and treatment of countless conditions. This type of minimally invasive surgery has become the most used worldwide due to its multiple benefits, among which fewer complications stand out, however, it is not exempt from presenting them.
Most Performed Surgeries
The low incidence of cases of complications of laparoscopic surgeries throughout the world could suggest a low importance of the problem. However, the main problems do not focus on the incidence which is very low. But on the fact that it is one of the most performed surgeries worldwide and its main complications. Especially the most frequent, are very serious and in many cases end in the death of the patient.
Studies Of the New Technique
The advancement of technology and the new techniques for entry into laparoscopic surgery make it imperative to carry out new research. Studies require to evaluate the new techniques since there is no evidence to guarantee the benefits of their use. And it is imperative that they support a lower risk of complications, especially vascular and intestinal injuries.
Conclusion
Despite the low incidence of cases of laparoscopic surgery complications compared to those presented by traditional surgery. It is essential to search for the improvement of existing techniques. Studies that guarantee their innocuousness and the creation of new techniques that decrease increasingly the number of complications presented and become an increasingly safe procedure.
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