General Abdominal Surgery

Complications, risks, and consequences

Estimated frequency

Most significant/serious complications

Infection^a

1–5 %

Wound

1–5 %

Intra-abdominal/pelvic

0.1–1 %

Bleeding/hematoma formation^a

Wound

1–5 %

Intra-abdominal

0.1–1 %

Rare significant/serious problems

Small bowel obstruction (early or late)^a,b [Anastomotic stenosis/adhesion formation]

0.1–1 %

Colostomy/ileostomy^a,b

0.1–1 %

Enterocutaneous fistula

<0.1 %

Deep venous thrombosis/pulmonary embolism

0.1–1 %

Multisystem failure (renal, pulmonary, cardiac failure)^a

0.1–1 %

Death^a

0.1–1 %

Less serious complications

Pain/tenderness (rib or wound pain)

Acute (<4 weeks)

>80 %

Chronic (>12 weeks)

1–5 %

Paralytic ileus

50–80 %

Incisional hernia^a (delayed heavy lifting/straining)

0.1–1 %

Wound scarring (poor cosmesis/wound deformity)

1–5 %

Nasogastric tube^a

1–5 %

Wound drain tube(s)^a

1–5 %

^aDependent on underlying pathology, anatomy, surgical technique and preferences

^bHigher with pelvic surgery

Perspective

See Table 2.1. The initial pathology for which the procedure is being performed largely determines the spectrum or risks and complications. Infection is the most serious complication and is associated with contamination, often from preexisting viscus perforation. Iatrogenic injury to the bowel may also occur, especially during division of adhesions. Established infection may lead to multisystem organ failure and requirement for intensive care in susceptible individuals. The presence of distal tube obstruction, in many situations, increases the risk of infection due to stasis and bacterial overgrowth. Postoperative leakage from an anastomosis or viscus repair may be catastrophic, leading to localized or generalized peritonitis or intra-abdominal abscess(es). Bleeding is usually not commonplace, if good operative technique is used. Occasionally, ileostomy or colostomy is required for safe management. Wound infection, small bowel obstruction, enterocutaneous fistula, and incisional hernia are significant, but fortunately uncommon complications or consequences.

Major Complications

The type of laparotomy, procedure, and patient characteristics largely dictate the risks and complications. Infection is potentially the most serious complication, and in the most severe form can lead to peritonitis, multisystem failure, and risk of death. Organ injury and bleeding can be significant and may require blood transfusion, although this is not common for most laparotomies. Occasionally, splenectomy is required for splenic injury, especially with left upper abdominal procedures. Deep venous thrombosis and pulmonary embolism is uncommon, but a higher risk is associated with pelvic surgery. Colostomy or ileostomy are significant consequences, which occasionally are necessary for bowel pathology, and may occur unexpectedly, which the patient should ideally be warned about for completeness. Wound infection, small bowel obstruction, enterocutaneous fistula, and incisional hernia are significant complications and consequences that should also be mentioned, but the less common nature of these can be emphasized to the patient.

Consent and Risk Reduction

Main Points to Explain