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Perioperative Komplikationen des unteren Gastrointestinaltraktes

Prävention, Erkennung, Therapie

Perioperative complications of the lower gastrointestinal tract

Prevention, recognition and treatment

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Zusammenfassung

Perioperative Komplikationen nach chirurgischen Eingriffen am unteren Gastrointestinaltrakt stellen nach wie vor ein relevantes Problem dar. Die perioperative Morbidität kann sowohl den unmittelbaren als auch langfristigen Therapieerfolg des einzelnen Patienten negativ beeinflussen. Zudem führt die entsprechend notwendige Diagnostik und Therapie zu zusätzlichen Kosten, die das Gesundheitssystem belasten. Idealerweise sollten Komplikationen durch präventive Maßnahmen verhindert werden. Im Falle einer Komplikation ist eine frühzeitige Erkennung derselben zur Einleitung der notwendigen Therapie essenziell.

In der postoperativen Phase ist die Wundheilungsstörung (bis zu 30 %) die am häufigsten berichtete Komplikation. Durch verschiedene perioperative Maßnahmen können bis zu 40–60 % der Wundinfektionen vermieden werden. Die Inzidenz der Anastomoseninsuffizenz wird in der Literatur je nach Lokalisation zwischen 1 und 23 % angegeben. Die therapeutische Strategie reicht von konservativen Maßnahmen, über interventionelle Methoden bis hin zur operativen Revision. Die frühpostoperative Fasziendehiszenz kommt in etwa 3 % der Fälle vor. Der Faszienverschluss mit kurzen Stichabständen scheint der Schlingennaht überlegen. Eine seltene, dennoch potenziell fatale Komplikation ist die Nachblutung. Die Identifikation der Patienten mit entsprechenden Risikofaktoren ist von großer Bedeutung. Dieser Beitrag fasst die Prävention, Erkennung und Therapie perioperativer Komplikationen nach Operationen des unteren Gastrointestinaltraktes zusammen.

Abstract

Perioperative complications following surgical procedures of the lower gastrointestinal tract still represent a relevant problem. The perioperative morbidity may negatively affect short and long-term outcomes of treatment of individual patients. The additional diagnostics and treatment required also lead to additional costs that burden the healthcare system. Ideally, complications should be avoided by preventive measures. In the event of a complication, early detection is essential for appropriate treatment.

Surgical site infections (SSI) have been described as the most common complication in the postoperative period and may occur in up to 30 % of cases. Through various perioperative measures up to 40–60 % of SSI are preventable. Depending on the location, the reported anastomotic leakage rate ranges from 1 % to 23 %. The therapeutic strategy ranges from conservative measures through interventional methods up to surgical revision. An early postoperative burst abdomen occurs in about 3 % of cases. A midline closure with small stitches and small suture distances (suture length to wound length ratio of 4) seems to be superior to large stitches with long distance intervals. A rare but potentially fatal complication is bleeding. The identification of patients with relevant risk factors is of great importance. This article summarizes the prevention, recognition and treatment of perioperative complications after surgery of the lower gastrointestinal tract.

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Literatur

  1. Albertsmeier M, Seiler CM, Fischer L et al (2012) Evaluation of the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy-a controlled prospective multicentre trial: ISSAAC [NCT005725079]. Langenbecks Arch Surg 397:363–371

    Article  PubMed Central  PubMed  Google Scholar 

  2. Allen BC, Barnhart H, Bashir M et al (2012) Diagnostic accuracy of intra-abdominal fluid collection characterization in the era of multidetector computed tomography. Am Surg 78:185–189

    PubMed  Google Scholar 

  3. Braga M, Ljungqvist O, Soeters P et al (2009) ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr 28:378–386

    Article  CAS  PubMed  Google Scholar 

  4. Brandstrup B, Tonnesen H, Beier-Holgersen R et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648

    Article  PubMed Central  PubMed  Google Scholar 

  5. Dauser B, Braunschmid T, Ghaffari S et al (2013) Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg 398:957–964

    Article  PubMed  Google Scholar 

  6. Delaney CP, Senagore AJ, Viscusi ER et al (2006) Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg 191:315–319

    Article  PubMed  Google Scholar 

  7. Diener MK, Knebel P, Kieser M et al (2014) Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 384:142–152

    Article  CAS  PubMed  Google Scholar 

  8. Francone TD, Saleem A, Read TA et al (2010) Ultimate fate of the leaking intestinal anastomosis: does leak mean permanent stoma? J Gastrointest Surg 14:987–992

    Article  PubMed  Google Scholar 

  9. Gheorghe A, Calvert M, Pinkney TD et al (2012) Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery. Ann Surg 255:1017–1029

    Article  PubMed  Google Scholar 

  10. Hyman N, Manchester TL, Osler T et al (2007) Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg 245:254–258

    Article  PubMed Central  PubMed  Google Scholar 

  11. Israelsson LA, Millbourn D (2012) Closing midline abdominal incisions. Langenbecks Arch Surg 397:1201–1207

    Article  PubMed  Google Scholar 

  12. Kartheuser AH, Leonard DF, Penninckx F et al (2013) Waist circumference and waist/hip ratio are better predictive risk factors for mortality and morbidity after colorectal surgery than body mass index and body surface area. Ann Surg 258:722–730

    Article  PubMed  Google Scholar 

  13. Kirchhoff P, Dincler S, Buchmann P (2008) A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg 248:259–265

    Article  PubMed  Google Scholar 

  14. Kosins AM, Scholz T, Cetinkaya M et al (2013) Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg 132:443–450

    Article  CAS  PubMed  Google Scholar 

  15. Kozek-Langenecker SA, Afshari A, Albaladejo P et al (2013) Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 30:270–382

    Article  PubMed  Google Scholar 

  16. Kronberg U, Kiran RP, Soliman MS et al (2011) A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg 253:78–81

    Article  PubMed  Google Scholar 

  17. Kulu Y, Ulrich A, Bruckner T et al (2013) Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 153:753–761

    Article  PubMed  Google Scholar 

  18. Li TF, Duan XH, Li Z et al (2014) Endovascular embolization for managing anastomotic bleeding after stapled digestive tract anastomosis. Acta Radiol

  19. Lubbers T, De Haan JJ, Luyer MD et al (2010) Cholecystokinin/Cholecystokinin-1 receptor-mediated peripheral activation of the afferent vagus by enteral nutrients attenuates inflammation in rats. Ann Surg 252:376–382

    Article  PubMed  Google Scholar 

  20. Malik AH, East JE, Buchanan GN et al (2008) Endoscopic haemostasis of staple-line haemorrhage following colorectal resection. Colorectal Dis 10:616–618

    Article  CAS  PubMed  Google Scholar 

  21. Mihaljevic AL, Schirren R, Ozer M et al (2014) Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net Trial (BaFO; NCT01181206). Ann Surg 260:730–739

    Article  PubMed  Google Scholar 

  22. Paun BC, Cassie S, Maclean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818

    Article  PubMed  Google Scholar 

  23. Platell C, Papadimitriou JM, Hall JC (2000) The influence of lavage on peritonitis. J Am Coll Surg 191:672–680

    Article  CAS  PubMed  Google Scholar 

  24. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351

    Article  PubMed  Google Scholar 

  25. Rondelli F, Bugiantella W, Vedovati MC et al (2014) To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Colorectal Dis 16:O35–O42

    Article  CAS  PubMed  Google Scholar 

  26. Sammour T, Kahokehr A, Srinivasa S et al (2011) Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 253:35–43

    Article  PubMed  Google Scholar 

  27. Seiler CM, Bruckner T, Diener MK et al (2009) Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 249:576–582

    Article  PubMed  Google Scholar 

  28. Singh PP, Zeng IS, Srinivasa S et al (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 101:339–346

    Article  CAS  PubMed  Google Scholar 

  29. Slim K, Vicaut E, Launay-Savary MV et al (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209

    Article  PubMed  Google Scholar 

  30. Story SK, Chamberlain RS (2009) A comprehensive review of evidence-based strategies to prevent and treat postoperative ileus. Dig Surg 26:265–275

    Article  PubMed  Google Scholar 

  31. Takakura Y, Hinoi T, Egi H et al (2013) Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg 398:833–839

    Article  PubMed  Google Scholar 

  32. Tekkis PP, Senagore AJ, Delaney CP et al (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed Central  PubMed  Google Scholar 

  33. Telem DA, Sur M, Tabrizian P et al (2010) Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: impact on patient management and outcome. Surgery 147:127–133

    Article  PubMed  Google Scholar 

  34. Ulrich AB, Seiler C, Rahbari N et al (2009) Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum 52:412–418

    Article  PubMed  Google Scholar 

  35. Valenti V, Hernandez-Lizoain JL, Baixauli J et al (2007) Analysis of early postoperative morbidity among patients with rectal cancer treated with and without neoadjuvant chemoradiotherapy. Ann Surg Oncol 14:1744–1751

    Article  PubMed  Google Scholar 

  36. Van Der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  Google Scholar 

  37. Vargo D (2012) Negative pressure wound therapy in the prevention of wound infection in high risk abdominal wound closures. Am J Surg 204:1021–1023 (discussion 1023–1024)

    Article  PubMed  Google Scholar 

  38. Zoucas E, Lydrup ML (2014) Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients. Patient Saf Surg 8:2

    Article  PubMed Central  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Y. Kulu, M.W. Büchler und A. Ulrich geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Y. Kulu, M.W. Büchler &  A. Ulrich

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  1. Y. Kulu
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  2. M.W. Büchler
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  3. A. Ulrich
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Correspondence to A. Ulrich.

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Kulu, Y., Büchler, M. & Ulrich, A. Perioperative Komplikationen des unteren Gastrointestinaltraktes. Chirurg 86, 311–318 (2015). https://doi.org/10.1007/s00104-014-2848-1

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  • DOI: https://doi.org/10.1007/s00104-014-2848-1

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