消化器外科領域の術後合併症とその対策　胃全摘術

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  • Postoperative Complication and Its Control Following Total Gastrectomy for Gastric Cancer.

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The secret of safe total gastrectomy with acceptable postoperative complications includes an appropriate approach and use of a retractor to provide a good operative field, keeping to the fundamentals in reconstruction, and effective drainage. The first choice for esophagogastrostomy is auto suture. Howerver, when problems occurred during auto suturing, repair should be done by hand suturing. Re-laparotomy is effective against primary postoperative bleeding and arterial embolization is effective against secondary postoperative bleeding. Anastomotic leakage can be cured by effective drainage, after its exact determination of its location, quantity and effectiveness of drainage by fluoroscopy. Massive bleeding due to pancreatic fistula can be controlled by arterial embolization. Conservative therapy using a long balloon catheter for intestinal obstruction due to adhesions should be continued for 7 to 10 days. When conservative treatment is ineffective against postoperative cholecystitis, percutaneous trnashepatic gall bladder drainage should be used. An abscess in the peritoneal cavity can be diagnosed by echography or computed tomography and drainage should be done under the guidance of echography or computed tomography.

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