Complications & Treatment
Whilst laparoscopic surgery confers many advantages to patients, abdominal complications have more subtle clinical presentations than is usual after an equivalent operation carried out by a traditional laparotomy incision. This is probably because the patient has not been subject to the stress of a major laparotomy and thus has near normal and resilient physiological responses. It is thus vital that intraperitoneal complications are recognised rapidly and corrected expeditiously. Sadly, bile leakage, bleeding and peritonitis often remain undiagnosed until circulatory collapse and septic shock occur.
The majority of patients undergoing a laparoscopic operation have relatively little pain and are eager to mobilise. Appetite is hardly depressed at all and pain is usually localised to the site of specimen extraction.
It is vital to think of an abdominal complication if any of the following symptoms/signs develop after 12 hrs of surgery.
- Pain requiring opiate analgesia
- Anorexia or reluctance to drink
- Reluctance to mobilise
- Nausea & vomiting
- Tachycardia
- Abdominal tenderness (may not have guarding)
- Abdominal distension
- Poor urine output
- Cardiac arrythmia
If no action is taken, it is likely that precipitous circulatory collapse and organ failure will occur.
Patients should be reviewed by a senior member of the surgical staff who needs to evaluate the patient in the context of the individual procedure that they have undergone. Whilst few patients will come to any harm if they undergo an unnecessary investigation, most will if a complication goes unrecognised for an unwarranted period of time.
- Ultrasound is extremely unreliable
- Re-laparoscopy offers prompt diagnosis and the possibility of laparoscopic lavage and corrective surgery.
- Sometimes CT is appropriate
|
PATIENT DISCHARGE INSTRUCTIONS – LAPAROSCOPIC COLON RESECTION
|
For your own safety, it is important that you do not drive or operate machinery, drink alcohol, or make important decisions or undertake business transactions, or take public transportation alone for 48 hours after surgery. It is normal to feel dizzy and sleepy or tired out after surgery. |
|
Activity |
Unrestricted, so long as you don’t experience too much pain. Keep yourself active, ie., don't take to your bed once you get home. Avoid driving for at least 72 hours or until most of your pain has gone. You should be able to return to your usual activities including work in 1-2 weeks. |
|
Dressings |
The ward nurses will remove your dressings before discharging you home. Leave the pieces of tape (steristrips) directly on your wounds for 7 days then pull these off in the bath. You should need no further dressings. Begin to shower or bathe the day after your operation. Expect some bruising and tenderness. |
|
Diet |
Drink plenty of water and eat lightly for 1-2 days after your operation. When resuming your usual diet post resectional surgery, keep away from high fibre foods. |
|
Medications |
Continue with your normal medicines. For pain, take two paracetamol by mouth every 6 hours along with an anti-inflammatory tablet eg., Diclofenac 75mg twice a day.
If you underwent a rectopexy wel will send you home with a supply of senna, glycerine suppositories and a microlax enema to use as necessary. |
|
Recovery |
Expect to feel reasonably well quite quickly (average 3-5 days). If you don’t, please consider phoning the ward. You may tire easily, after all it is still major surgery and not have a lot of energy for a few days to a week. |
|
Discharge |
You will usually be discharged within 48hrs of your operation. If you are not doing well or have questions, please ask us! |
|
Clinic follow-up |
The ward receptionist will make you an appointment to be seen 1-2 weeks after discharge, or as we’ve otherwise instructed you. This allows us to see how you are and talk through any further treatment required. |
WHEN TO CALL YOUR DOCTOR
Be sure to call your GP or surgeon if you develop any of the following:
- Persistent fever over 39 C
- Pulse >100 or respiratory rate >30
- Increasing pain
- Fresh rectal bleeding
- Increasing abdominal swelling
- Persistent nausea and or vomiting
- Diarrhoea
- Chills
- Persistent cough or shortness of breath
- Purulent drainage from any incision
- Redness surrounding any of your incisions that is getting bigger
- You are unable to eat or drink liquids
- Painful swolen calf or leg
If you can not get hold of either of the above, call the ward and go to the A&E department. Explain that you had a resent laparoscopic resection and that you need a surgical review.
Bristol Laparoscopic Associates
policy is to ensure that all of our patients are given appropriate contact details of the NBT (Frenchay) or BRI emergency on-call SpR and are instructed to attend the hospital direct (A&E) rather than visit their GP or another hospital.
|
|
|