Surgical Harms Postoperative Complications

The mortality of gastrectomy remains high in nonspecialist settings, and appears to be higher in low-volume units (73), in elderly or unfit patients (47), and perhaps in males. Gastrectomy shares many postoperative complications with other major abdominal operations. In addition to the major complications leading to postoperative mortality, there are a variety of others of importance shown in the following table. Bleeding and wound dehiscence are relatively rare, as are deep vein thrombosis and pulmonary embolus in modern practice, but this remains highly lethal when it does occur. The issue of hospital-acquired infection has grown in importance over the last decade, and the risk of acquiring invasive methycillin-resistant Staphylococcus aureus (MRSA) infection or Clostridium difficile colitis is now a significant problem in many hospitals.

Postoperative Complications After Gastrectomy

Respiratory tract infection/adult respiratory distress syndrome

Myocardial infarction

Cardiac failure

Atrial fibrillation

Other arrhythmias

Abscess

Wound infection

Anastomotic leakage

Leakage from duodenal stump

Enteric fistula

Pancreatic fistula

Hemorrhage

Wound dehiscence

Hospital-acquired specific infection (MRSA/

Clostridium difficile) Deep vein thrombosis Pulmonary thromboembolism

Abbreviation: MSRA, methycillin-resistant Staphylococcus aureus.

In addition to the complications described, the normal, uncomplicated course of events after a gastrectomy will include a number of expected but undesirable health consequences. The weakness and tiredness associated with any major surgery usually takes several months to resolve completely, and in the case of gastrectomy, this is further added to by the nutritional problems induced by removal of part or all of the stomach. Patients can expect to have a smaller appetite and small capacity, and to lose weight for some time after leaving hospital until they reach a stable metabolic state.

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