Laparoscopic Surgery Preoperative and Postoperative Complications

 

Laparoscopic Surgery

Because of the inclusion of trocars through the stomach divider, laparoscopy comprises of the making of a pneumoperitoneum by insufflation of CO 2, permitting a surgery to act in the peritoneal hole. Note, CO 2 is a scentless, vapid, economical and non-combustible gas.

During their internship in laparoscopic technique, many of them have not received practical training with simulators Lap Trainer Box.

Laparoscopy Postoperative Complications

The bleeding complication is still present and explained by insufficient hemostasis or a loose suture. It often requires surgical revision.

The postoperative pain is the result of three components:

• Wall pain due to irritation / inflammation of the peritoneal serosa linked to CO 2 ;

• Visceral pain by direct tissue injury (tissue dissection, electrocoagulation, ligation, trocar insertion points, etc.) Which is responsible for postoperative pain, easily controllable by analgesics in levels one to three;

• Scapular pain, frequent and attributable to the residual presence of CO 2 between the right diaphragmatic cupola and the hepatic dome, exerting a traction of the liver on the phrenohepatic ligaments. Hence the need for careful exsufflation of the pneumoperitoneum which must be systematic at the end of the operation.

Finally, the infiltration of local anesthetic intraperitoneally or at the level of the trocar incisions seems relatively effective. In the aftermath of laparoscopic surgery, the spastic pain induced by the postoperative ileus is less, with rapid resumption of transit.

Apfel Score Laparoscopy

Laparoscopic surgery also promotes the onset of postoperative nausea and vomiting (PONV). In order to prevent and limit their incidence, the use of antiemetics (droperidol, dexamethasone, ondansetron) during and after surgery is systematic; particularly in patients with an Apfel score greater than two, for optimal patient comfort.

Intraoperatively, the venous stasis induced by the pneumoperitoneum and the position during the operation (proclive) favors thromboembolic disease. In order to prevent thromboembolic complications, the wearing of compression stockings is essential, more or less associated with the medical prescription (PM) of low molecular weight heparin (LMWH) postoperatively, depending on the surgical context, the procedure and its duration and the patient's history.

Outside of a localized infectious context, such as peritonitis, infectious complications remain rare.

Preoperatively

Nursing care

The nurse (IDE) welcomes the patient and checks his medical file (identity, medical-surgical history, allergies, etc.) as well as the presence of a blood group card and the search for irregular agglutinins (RAI) in course of validity. The first constants - heart rate (HR), blood pressure (BP), temperature - notify in the care record. The absence of jewelry, dentures, contact lenses and hearing aids is checked. On medical prescription, the patient's usual treatment can dispense if necessary.

Postoperatively

After monitoring for one to two hours in the post-intervention care room, postoperative care in the surgical department is common to any surgical procedure.

Paramedical monitoring consists of evaluating consciousness, hemodynamic (HR, BP) and respiratory constants (respiratory frequency, rhythm and amplitude, saturation), temperature, side effects linked to anesthesia (nausea, vomiting, drowsiness, pain in throat after intubation), assessment of pain and its location, nausea / vomiting, diuresis, dressings (integrity, discharge) and any drainages.

The search for complications remains a priority. Bleeding complications (hemodynamic instability, pain, pallor, bleeding from the incisions of the trocars or redons) often require revision surgery, more rarely blood transfusion. Infectious complications (fever, redness, pain, purulent discharge) are extremely rare. Finally, thromboembolic complications are always to fear and prevent by wearing compression stockings. 

Early mobilization of the patient and possibly the medical prescription of LMWH, depending on the surgical context and the patient's history. The first lift will perform as soon as possible on PM, subject to correct hemodynamic constants. The resumption of food and drinks will depend on the nature of the intervention and after surgical advice. PMs will implement and all this information will notifiy in the patient's file.

Depending on the nature of the intervention and the context, home discharge may consider the same day as the operation (outpatient hospitalization), the average hospital stay varying from two to five days.

Conclusion

The management of patients operated on by laparoscopy has markedly reduced postoperative complications and contributes to improving postoperative rehabilitation. This practice responds to a triple challenge: for the patient, in terms of physical and psychological comfort, for the multidisciplinary team, due to an optimization of the care, and economic, due to a reduction in complications and a reduction in the length of stays.

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