Are Major Complications After Digestive Surgery Preventable?

Chapter

Abstract

Whenever questions arise about major complications after Digestive surgery, the actual morbidity rates of the respective types of surgery are warranted and important for the judgment of the clinical relevance and the continuous improvement of surgical management. There have been major advances in the reduction of postoperative complications following Digestive Surgery in the past years. The reasons for the improved outcome reside—beside others—in improved diagnostic tests leading to early intervention and a more precise surgical approach, better neoadjuvant treatment options, and improved peri- and postoperative care and in modified and innovative surgical techniques or devices. Surgical clinical trials have provided evidence of how to treat and prevent complications and abandoned some traditional treatment protocols that clearly had no benefit for the surgical outcome. A breakthrough in reduction of postoperative morbidity and improved surgical outcome has been provoked by the centralization of complex operations at specialized surgical high-volume centers.

Keywords

Digestive Surgery Complications Morbidity rates Preoperative setting Surgical technique Perioperative setting Postoperative setting Prevention 

References

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–8.Google Scholar
  4. 4.
    Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Post-pancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care. 2010;48:1041–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Kapiteijn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg. 2002;89:1142–9.PubMedCrossRefGoogle Scholar
  8. 8.
    van Gijn W, Krijnen P, Lemmens VE, den Dulk M, Putter H, van de Velde CJ. Quality assurance in rectal cancer treatment in the Netherlands: a catch up compared to colon cancer treatment. Eur J Surg Oncol. 2010;36:340–4.PubMedCrossRefGoogle Scholar
  9. 9.
    van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.PubMedCrossRefGoogle Scholar
  10. 10.
    van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–37.PubMedCrossRefGoogle Scholar
  11. 11.
    Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713–24.Google Scholar
  12. 12.
    Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. 2009;250:119–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Cerantola Y, Hubner M, Grass F, Demartines N, Schafer M. Immunonutrition in gastrointestinal surgery. Br J Surg. 2011;98:37–48.PubMedCrossRefGoogle Scholar
  14. 14.
    Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Van't Sant HP, Weidema WF, Hop WC, Oostvogel HJ, Contant CM. The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg. 2010;251:59–63.CrossRefGoogle Scholar
  16. 16.
    Businger A, Grunder G, Guenin MO, Ackermann C, Peterli R, von Flue M. Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland – a survey. Langenbecks Arch Surg. 2010;396:107–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52:412–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Gurusamy KS, Samraj K. Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev. 2007;CD006003.Google Scholar
  19. 19.
    Gurusamy KS, Samraj K, Davidson BR. Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev. 2007;CD006232.Google Scholar
  20. 20.
    Jesus EC, Karliczek A, Matos D, Castro AA, Atallah AN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004;CD002100.Google Scholar
  21. 21.
    Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg. 2010;252:207–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010;251:843–56.PubMedCrossRefGoogle Scholar
  23. 23.
    Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg. 2009;96:331–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology. 2009;136:842–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev. 2010;CD008370.Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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