Complications of laparoscopy: causes and types
Laparoscopic surgery is a surgical intervention with minimal trauma to the patient. This procedure allows the surgeon through a small incision to examine the abdominal organs.
The tool used for carrying out laparoscopy is called a laparoscope and is a rigid tube with a flashlight and camera attached to the monitor, which displays an image of the abdominal cavity from the inside.
Laparoscopy is now widely used in surgery; the benefits are obvious:
- small blood loss during surgery;
- the possibility of a more thorough examination of the abdominal cavity;
- less trauma to the pelvic organs, which contributes to more rapid recovery of body functions and reducing the formation of postoperative adhesions;
- reducing the risk of infection with microorganisms and foreign bodies;
- short period of hospitalization and recovery.
Laparoscopy is considered a safe and less traumatic procedure. Complications may happen rarely, serious complications – even in isolated cases. This is mainly damage to internal organs, and cardiovascular injury. Doctors ‘ mistakes during the operation or General health of the patient at the time of the operation, its reaction to the anesthesia may cause complications.
How’s the operation and the postoperative period?
- The last meal should be at least 6 — 12 hours prior to the procedure (depending on the type of laparoscopy). The next day after surgery, the patient can go home.
- Laparoscopy is performed under General anesthesia.
- The navel, the surgeon makes incisions (1 — 1.5 cm). The Veress needle through the abdomen is filled with carbon dioxide, then one incision is used the laparoscope. The use of gas allows to ensure visibility of internal organs during the operation. The laparoscope, equipped with a flashlight and a camera, displays the image on a monitor, allowing the surgeon to consider in detail the abdominal cavity. Through the other incisions in the navel surgical instruments are inserted needed to remove the affected organ.
- At the final stage, carbon dioxide is released from the abdominal cavity is injected antiseptic. After the so-called flushing fluid is pumped, sutures and bandages on trocaria wounds.
- After laparoscopy, patients may experience mild discomfort, in some cases there may be nausea, vomiting. Within a few days the symptoms disappear.
The causes of complications after laparoscopy
- The change in visual perception associated with the transition from three-dimensional vision of the object if the open operations for two-dimensional image in the eyepiece.
- The lack of tactile sensations with which most surgeons are distinguished pathologically modified tissue from the healthy.
- The technological complexity of the procedure. The failure of one of the devices or any part of the optical system can lead to a critical situation, when the completion of the laparoscopic examination is impossible and it is necessary to resort to laparotomy.
- A laparoscope gives a magnified image, but narrows the field of view. What happens outside of it can go unnoticed and cause complications.
The main types of complications
Damage to internal organs
The first trocar and the Veress needle is introduced into the peritoneal cavity blindly, for this reason, the risk of damage to internal organs even by an experienced surgeon are high.
To minimize these risks, developed a special technique introduction of instruments used, created safe design of trocars (protective caps on sharp stilettos), and Veress needle (blunt spring-loaded core), and before the introduction of the instrument are special tests.
But all these precautions do not entirely eliminate the possibility of damage to adjacent organs such as the stomach, liver, intestines, blood vessels.
With timely detection of damage, the surgeon will eliminate them quickly, stopping the bleeding and sewing up the injured organ.
If the bleeding is internal on too strong and impossible to define its nature, the doctor carries out a laparotomy. With weak bleeding in most cases used expectant management.
Older women are at risk of blood clots during the procedure of laparoscopy, as well as in the postoperative period. To minimize the risk of this complication, prior to laparoscopy, the patient bandage the legs with an elastic bandage, even if she doesn’t have varicose veins, as well as prescribed blood thinners.
At risk of blood clots are also patients who have problems with heart and vessels (heart disease, hypertension, coronary artery disease, previously transferred heart attack), atherosclerosis, obesity, varicose veins in the legs.
Malfunction of the heart, blood vessels and respiratory system
To increase the volume of the abdominal cavity and spread to the organs, through a semicircular incision in the crease of the navel into the abdominal cavity injected carbon risk. Such manipulation reduces the risk of injury to nearby organs. But carbon dioxide affects the pressure. If the patient suffers from diseases of the cardiovascular and respiratory systems, the operation is performed with the low-pressure carbon dioxide.
When performing a laparoscopy there is a possibility of burns to internal organs. The reason for this is a small field of view for the surgeon performing the operation. Defect surgical instruments may also cause burns.
Time is not seen by a burn surgeon is threatened by necrosis and peritonitis.
The physician cauterizing the wound to stop the bleeding in the introduction of the trocars, may also trigger the burn. The reasons for this are: damage of electrical insulation medical instrument for coagulation or failure to follow doctor safety rules of operation.
Bleeding from the places of introduction of the trocars
At the final stage of a laparoscopy is performed suturing trocar holes through all of the damaged layers. That is why the risk of heavy bleeding is minimal.
If the patient has any bleeding, the cause of this phenomenon may be bleeding disorders.
Suppuration around the wound traganou
Prerequisites to this complication when performing a laparoscopy may be low immunity of the patient and surgical manipulacije when extracted from the abdominal cavity of the damaged organ through treacherou hole.
Plastic airtight containers are designed for placing the remote on and help to avoid this complication. But due to their high cost, not every patient will agree on their application.
Metastases in the region of the trocar holes
If the body is removed laparoscopically, affected with malignant tumor, there is a risk of damage to the skin and subcutaneous layers in the area to extract it from the abdominal cavity. This is because cancer cells remain in the skin at the incision site.
To avoid this complication, also used a plastic airtight containers.
This type of complications after surgery is extremely rare. To prevent the formation of hernia, is the closure of all trocar holes with a diameter greater than 1 centimeter. The doctor carries out control at the end of surgery by palpation.
Complications of laparoscopy can eliminate the time to recognize them. For this reason, the operation should begin with an overview that aims timely diagnosis of complications of the initial phase of surgery.
It is important to note that when carrying out laparoscopic surgery by a qualified surgeon and anesthesiologist with extensive experience the risk of complications is reduced to almost zero. The doctor should have a clear plan of action depending on the occurrence of one or the other complications that would prevent or safely eliminate them during the operation.
If you encounter any difficulties during laparoscopy, the surgeon will proceed to laparotomy is not as one of the complications of the operation, and as the optimal surgical tactics, allowing you to safely cure the patient from the disease.