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Postoperative complications and their prevention

  • Pain
    • Mainly due to blood seepage in wound that can be wash out with normal saline and repeated it on every step of wound closure.
    • Stitching  of muscle fibres is pain full and can be avoided by stitching the epimysium only.
    • Slough in wound that can be reduced by gentle handling of tissue and avoiding the cauterization.
    • Early mobilize the patient so body do not go in spasm.
    • Chronic pain usually due to post operative adhesion, some time not removing the appendix completely.
  • Wound infection
    • Common complication and present with pain and erythema of wound on 3rd post operative day or onward, treated by wound drainage and antibiotic when required.
      • Mainly due to contamination of wound with purulent organisms and providing them the suitable environment to grow (blood, dead  or devitalized tissue, foreign bodies). This can be reduced by giving preoperative antibiotic cover, avoiding contamination of wound be taking special measures e.g. directly sucking out the puss, paint the wound with antiseptic, or wall of the operative area. Dead tissue depend on tissue handling and use of cautery.
  • Intra-abdominal abscess.
    • Relatively rare complication after routine use of preoperative antibiotics.
    • Interlope, paracolic, pelvic and subphrenic sites should be considered, abdominal ultrasonography and CT scan help in diagnosis.
    • Mainly due to leaving behind infective focus e.g. faecolith, dead tissue,  dead space with oozing wall that is not drain.
  • Ileus
    • Mainly due to intra abdominal sepsis, imbalance electrolytes, late orally allowing, not moving the patient early. Intra abdominal sepsis mainly need drainage antibiotic  cover and improving general condition of patient.
  • Respiratory
    • Avoid general anesthesia, early mobilize the patient, helping him in coughing out or nebulize him.
  • Venous thrombosis and embolization
    • Early mobilize the patient and appropriate prophylactic measures should be taken to prevention it if needed.
  • Portal pyaemia
    • This is a rare but very serious complication of gangrenous appendicitis associated with high fever, rigors and jaundice.
    • It is caused by septicemia in the portal venous system and leads to the development of intrahepatic abscesses (often multiple).
    • Treatment is with systemic antibiotics and percutaneous drainage of hepatic abscesses as appropriate.
    • Improve the general condition of patent e.g. anemia.
  • Faecal fistula
    • Leaking from the appendicular stump occur rarely in cases of difficult appendicectomy  particularly when operating on appendicular mass or abscess.
    • Expertise of surgeon do maters, and usually heal on conservative management
  • Adhesive intestinal obstruction.
    • Most common late complication of appendicectomy when gut handling is rough and patient is not early mobilized.
  • Incesional hernia
    • Post operative sepsis, ileus, cough and especially not closing the peritoneal sheath.