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Intraoperative Komplikationen des unteren Gastrointestinaltraktes

Prävention, Erkennung, Therapie

Intraoperative complications of the lower gastrointestinal tract

Prevention, recognition and therapy

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Zusammenfassung

Jeder operative Eingriff ist mit dem Risiko intraoperativer Komplikationen behaftet. Diese treten bei etwa 2–12 % der Patienten auf, beeinflussen aber wesentlich das postoperative Outcome, Gesamtkomplikationsrate und Letalität. Diese Arbeit stellt die Behandlung der typischen intraoperativen Komplikationen bei Operationen am unteren Gastrointestinaltrakt dar. Einen Schwerpunkt bildet dabei die Prophylaxe und Beschreibung von Risikofaktoren. Besonders bei einer Veränderung der normalen Anatomie durch Voroperationen, Entzündungen oder Tumoren sowie in Notfallsituationen oder einer nicht abgeschlossenen Lernkurve steigt das Risiko für Verletzungen an Darm, Milz, Ureter oder Gefäßen. Diese Risikofaktoren müssen bei der Wahl des operativen Vorgehens, des operativen Zugangsweges und des geeigneten Operateurs berücksichtigt werden. Die frühzeitige Erkennung der Komplikation mit einer definitiven Versorgung möglichst schon beim Primäreingriff ist der wesentliche Schritt für die erfolgreiche Therapie ohne Langzeitfolgen. Die verzögerte Therapie ist mit einer ungleich hohen Morbidität und Letalität behaftet und sollte vermieden werden.

Abstract

Every surgical intervention is associated with the risk of intraoperative complications. These occur in approximately 2–12 % of patients but significantly influence the postoperative outcome, overall complication and mortality rates. This article presents the treatment of typical intraoperative complications during surgery of the lower gastrointestinal tract with a focus on the prevention and identification of risk factors. Especially changes in the regular anatomy caused by previous surgery, inflammation, tumors and emergency situations carry the risk of iatrogenic injuries to the bowels, spleen, ureter and blood vessels. These risk factors must be considered when choosing a surgical procedure, a surgical approach or an appropriate surgeon. The early detection of complications with a definitive restoration is the essential step for a successful treatment without long-term sequelae. Every delay in therapy is associated with an increased morbidity and mortality and should be avoided.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.-P. Ritz gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Wismarsche Str. 393–397, 19049, Schwerin, Deutschland

    J.-P. Ritz

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Correspondence to J.-P. Ritz.

Zusatzmaterial online

104_2014_2849_MOESM1_ESM.pdf

Beispiel einer präoperativen interdisziplinären Checkliste zur Erfassung des kardiopulmonalen Risikos, sowie einer intraoperativen Sicherheits-Checkliste mit Unterteilung in Sign-in und Sign-out (beide Checklisten mit freundlicher Genehmigung der Helios-Kliniken GmbH). (PDF 105KB)

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Ritz, JP. Intraoperative Komplikationen des unteren Gastrointestinaltraktes. Chirurg 86, 319–325 (2015). https://doi.org/10.1007/s00104-014-2849-0

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