Everything You Need to Know about Common Postoperative Complications
It is quite common to experience postoperative complications following any surgery, including abdominal hernia surgery, gallbladder surgery, belly button hernia surgery, etc. These complications occur immediately or a few days following the surgery. Being aware of these complications will help you be prepared and also take the proper measures to prevent them.
General Postoperative Complications
It can be caused by various factors, including:
- Pre-existing infection
- Necrosis and tissue damage at the surgery site
- Drug reaction or blood transfusion
- Pulmonary atelectasis
- Specific infections associated with the surgery, such as UTI following urological surgery and biliary infection following biliary surgery
- Chest infection
- Anastomosis leak
- Drip site infection or phlebitis
- Subphrenic or pelvic abscess
- Wound infection
After One Week
- Pulmonary embolism
- DVT (deep vein thrombosis)
Postoperative morbidity in abdominal surgery is caused by infections. Though it is reduced by taking prophylactic antibiotics, multi-resistant organisms can present a significant challenge.
Skin staphylococci can lead to wound infection within seven days following surgery, causing redness, pain, and slight discharge.
Cellulitis and Abscesses
They generally occur following bowel-related surgery within the first week, third week, or even after discharge. Antibiotics are used to treat cellulitis, whereas:
- A mild abscess requires suture removal and probing of the wound
- A deeper abscess requires surgical re-exploration
It is caused by clostridium perfringens (a bacterium), which produces gas-releasing toxins that lead to tissue death.
A deep chronic abscess occurring after normal healing due to non-absorbable mesh or suture causes wound sinus. It requires surgical re-exploration to remove the mesh/suture.
Wound dehiscence is when the wound begins to open up either partially or completely along the sutures. It usually occurs within 7-10 days post-surgery and is often identified by serosanguinous discharge from the wound. It can be managed with a sterile dressing to the wound, opiate analgesia, fluid resuscitation, or re-suture under general anesthesia.
Large volumes of blood transfusion may exacerbate hemorrhage by consumption coagulopathy. Unrecognized bleeding diathesis or preoperative anticoagulants may also cause hemorrhage. It can be managed with:
- Clotting screen and platelet count
- Good intravenous (IV) access
- Central venous pressure (CVP) catheter (only upon significant bleeding)
- Fresh frozen plasma (FFP) or platelet concentrates
Late postoperative hemorrhage is usually caused by the infection damaging the blood vessels at the surgery site. It requires infection treatment and surgical re-exploration.
It occurs between 1 and 15 years after surgery, causing a bulge in the abdominal wall near the previous wound. It is usually asymptomatic but causes pain during strangulation.
Risk factors of incisional hernia are:
- Distension and poor muscle tone
- Wound infection
- Using the same incisional site
Incisional hernia can be managed or prevented by using:
- A transverse incision
- A suture technique with small bites (wound to suture length ratio of 1:4)
- Prophylactic mesh in an onlay position
Disordered Wound Healing
It is caused by:
- Malnutrition and vitamin deficiency
- Poor blood supply
- Severe rheumatoid disease
- Excess suture tension
- Radiotherapy and immunosuppressive therapy
- Prolonged use of steroids
It is an infection affecting any part of the urinary system, including kidneys, urethra, or bladder. It can be treated with antibiotics and fluid intake.
It is a condition characterized by difficulty emptying the bladder. It can be managed with sufficient analgesia or catheterization.
Acute Kidney Injury
It is the sudden damage or failure of kidneys caused by antibiotics, aorta surgery, obstructive jaundice, and severe or prolonged hypertension.
Risk factors of acute kidney injury are:
- Liver disease
- Peripheral arterial disease
- High-risk surgery
Mild cases of acute kidney injury can be treated with fluid restriction (until tubular function recovers) whereas, severe cases may require dialysis or hemofiltration (in which the function recovers gradually within weeks or months).
Nerve damage occurs during various procedures, including:
- Total parotidectomy (facial nerve damage)
- Thyroidectomy (recurrent laryngeal nerve damage)
- Prostate surgery (impotence)
Injuries such as falls, nerve palsies, diathermy burns, and damage to diseased bones and joints may occur during positioning or transporting to the ward.
DVT and pulmonary embolism are the major causes of mortality and complications post-surgery.
It is a blood clot formed in the deep vein (usually in the legs), causing tenderness of the calf muscle, swollen legs, and increased warmth with calf pain on passive dorsiflexion of the foot.
It occurs when a blood clot blocks one or more arteries in the lungs. It causes sudden dyspnea and cardiovascular collapse with pleuritic chest pain, pleural rub, confusion, breathlessness, and hemoptysis.
Atelectasis (alveolar collapse)
It occurs when airways in the lungs are obstructed by bronchial secretions. It causes mild tachypnea and tachycardia and slow recovery from surgery. It can be prevented by preoperative and postoperative physiotherapy.
It is an infection of one or both lungs caused by microorganisms. It can be treated with physiotherapy and antibiotics.
Patients who aspirate (inhale) gastric contents during surgery can develop pneumonitis or aspiration pneumonitis. It causes vomiting or regurgitation with rapid onset of breathlessness and wheezing. It can be prevented by crash induction technique and oral antacids or metoclopramide.
Acute Respiratory Distress Syndrome
It occurs when fluids collect in the lungs’ air sacs, thus causing rapid, shallow breathing and severe hypoxemia with scattered crepitation. It requires intensive care with medical ventilation.
Bowel Surgery Complications
Early Mechanical Obstruction
It can be caused by a trapped/twisted bowel loop or adhesions occurring around one-week post-surgery. It may require surgery or can be managed with nasogastric aspiration and IV fluid.
Delayed Return of Function
- Ileus or Temporary Disruption of Peristalsis – It is a condition where the intestine cannot remove waste from the body. It causes symptoms such as nausea, vomiting, and can lead to anorexia after the re-introduction of fluids.
- Adynamic Obstruction – It is intolerance to oral intake caused after abdominal or pelvic surgery. It may require surgery or can be managed with food restrictions.
Anastomotic Leakage or Breakdown
Small leaks can cause localized abscesses with delayed bowel function recovery. It can be resolved with IV fluids and delayed oral intake. Otherwise, surgery may be needed.
It causes progressive sepsis and generalized peritonitis, which can be managed with antibiotics or may need surgery.
Late Mechanical Obstruction
It is caused by persistent adhesions, presenting isolated episodes of small bowel obstruction after months or years following surgery.
How to Prevent Postoperative Complications
- Maintain optimal weight and nutritional status
- Resolve anemia and intra-operative blood loss
- Prepare your bowel for specific procedures like colorectal surgery and hemorrhoidectomy
- Take postoperative analgesia to manage pain
- Take antibiotics before surgery to prevent infections
Contact us today at Far North Surgery if you are looking for an effective alternative to conventional open surgery. Our surgeon, Dr. Madhu Prasad, has years of experience and expertise in performing minimally invasive procedures that ensure a quick recovery and minimize complications.