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Complications after biliary tract surgery

A serious complication in the postoperative period is bleeding. It can occur from ligature slipping from the cystic artery, from damage to the liver, from the cystic bed, from unconnected vessels in intersected junctions, in the separated omentum and in the mesentery of the transverse colon, from a wound in the abdominal wall. Bleeding can be from a variety of small vessels due to bleeding with jaundice. Vigorous measures are needed, sometimes opening a wound and bandaging a bleeding vessel or leaving a clamp on it, with parenchymal bleeding, tamponade using a hemostatic sponge, along with blood transfusion and anti—shock measures.
A rare complication in the postoperative period is the accumulation of large amounts of bile under the liver or even under the diaphragm, mainly after choledochotomy. Much less often, bile leaks out of the gallbladder bed or pours out of the cystic duct. This accumulation of sediment from the free abdominal cavity contains 1-2 liters or more of bile with an admixture of blood and lymph. Possible displacement of the liver on this basis. The disorders are significant: it is impossible to take a deep breath, pain in the right hypochondrium and chest on the right, fever, leukocytosis. It is necessary to open the wound at its right end, release the bile and introduce drains.
Irritation of the peritoneum with rapid intake of large amounts of bile can cause severe shock with a drop in blood pressure and lead to death of the patient. On the other hand, it happens that the peritoneum reacts poorly to bile and the patient's condition is little disturbed on the first day when the stomach is stretched with bile. Then peritonitis develops. When bile is poured into the free abdominal cavity, an urgent relaparotomy is indicated.
The next serious complication is the development of jaundice in the very next few days after surgery. The nature of its appearance, development and course, severity, and features of the general disorders and disorders accompanying it make it possible, taking into account the history of the disease and the data established during surgery, to make an assumption about the causes of its occurrence and outline therapeutic measures. The most common cause of jaundice after cholecystectomy, choledochotomy and other operations on the biliary tract is the occurrence of mechanical obstruction during hepatocoledoch, primarily due to improper actions of the surgeon. This is damage to the duct, the imposition of a ligature or sutures covering the lumen. Urgent relaparotomy is often necessary in these patients. Much less often, jaundice that occurs immediately after surgery is caused by a stone in the choledochus that has descended from the intrahepatic ducts or examined during surgery, which has now blocked its lower end. Jaundice of a different origin is even less common in the first days after surgery. There are many causes: cholangitis, hepatitis, acute liver failure, reaction to blood transfusion of inappropriate group affiliation, pylephlebitis, unnoticed cancer metastases in the liver, etc. The causes of late onset of jaundice — several weeks and months after surgery — are most often viewed and left in the choledochus stones and scarring of lesions in the ducts with the formation of strictures. This, as well as damage to the ducts during surgery and the ligature slipping off the cystic duct, leads to the appearance of biliary fistulas in the postoperative period.
A common postoperative complication is pneumonia. Occasionally, an effusion in the pleural cavity is observed, usually on the right, but occasionally on the left. Even pronounced forms are visible: chest X-ray examination in the postoperative period is rarely performed in these patients. Severe complications, which are among the most common causes of death in patients after biliary tract surgery, are heart muscle failure, liver functional failure, and much less often kidney failure.
A very dangerous complication is the outbreak of acute pancreatitis. Vigorous treatment is necessary with exclusively parenteral nutrition, copious administration of fluids, sufficient amounts of sodium chloride and vitamins, constant suction of stomach contents with a thin probe inserted through the nose, the appointment of broad-spectrum antibiotics, atropine, etc. In case of abscessing, a relaparatomy is necessary. Lighter forms, presumably, are not so rare, but are not recognized.
Shock after these operations is rare. Thromboembolic complications are occasionally observed.
Acute arteriomesenteric obstruction and some other complications are discussed in the chapters on preparing patients for surgery, on postoperative care, and on anesthesia.
Complications include the formation of a hematoma in the surgical wound, its suppuration, the appearance of subdiaphragmatic and subhepatic ulcers, as well as persistent mucous and ligature fistulas. При оформленні документів для виїзду на постійне місце проживання за кордон, громадяни України часто стикаються з необхідністю зібрати значну кількість паперів, які засвідчують їхню особу та репутацію. Серед них обов'язковою є довідка з Міністерства внутрішніх справ, яка підтверджує відсутність судимості на території нашої держави. Це довідка про несудимість з апостилем має бути перекладений мовою країни призначення та нотаріально завірений, що додає часу до процедури. Термін його дії для консульських установ зазвичай становить до пів року, що дає змогу завершити всі формальності. Оформити документ його правильне оформлення.