Gastrointestinal Surgery by Timothy M. Pawlik Shishir K. Maithel & Nipun B. Merchant

Author:Timothy M. Pawlik, Shishir K. Maithel & Nipun B. Merchant
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Periprocedural Management

Preanesthetic consultation and routine blood tests including a coagulation profile are systematically required. Similarly, the vast majority of the patients have contaminated bile, and it is mandatory to systematically start antibiotherapy prophylaxis before the procedure in order to prevent the occurrence of severe septic complications during manipulation of the bile ducts. Antibiotics are generally continued for at least 2–5 days following the procedure. Since most of the patients will require several therapeutic sessions, it is important to adapt the antibiotics to the microbiological findings of previous interventions. After the procedure, occurrence of blood in the drainages should lead to immediate elimination of vascular complications such as active hemorrhage, hematoma, or pseudo-aneurism on CT scan. Similarly, in patients with external drainage, tubes should be flushed daily with 5–10 ml of saline to ensure adequate bile outflow and bile loss should be rigorously compensated. If occlusion is suspected in the absence of bile outflow, proper fixation of the drainage should be verified and tubes may be flushed with 5–10 ml of saline. In the persisting absence of bile outflow, radiological assessment of the drainage with standard X-ray, CT scan, or percutaneous cholangiography should be undertaken. Finally, when the internal–external drainage has been placed, occurrence of moderate fever or mild elevation of hepatic enzymes is common after first occlusion of the external part of the drain and should lead to its reopening. After a few days, a new attempt might be undertaken. In case of recurring symptoms, control of catheter placement should be undertaken.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.