Skip to main content
Springer Nature Link
Log in

Postoperative Complications

  • Chapter
  • First Online:
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

Whether practicing in a small rural hospital or a large tertiary referral center, colorectal surgeons will encounter a variety of postoperative complications. The ability to minimize, recognize, and effectively treat these problems is paramount to achieving quality outcomes for our patients. This chapter focuses on those surgical complications most often encountered by colorectal surgeons: injuries to the bowel and genitourinary structures, pelvic hemorrhage, small bowel obstruction, wound infections, abscesses, and anastomotic leaks, strictures, and bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Sancho JJ, di Costanzo J, Nubiola P, et al. Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula. Br J Surg. 1995;82(5):638–41.

    Article  CAS  Google Scholar 

  2. Berry SM, Fischer JE. Enterocutaneous fistulas. Curr Probl Surg. 1994;31(6):469–566.

    Article  CAS  Google Scholar 

  3. Joyce MR, Dietz DW. Management of complicated gastrointestinal fistulas. Curr Probl Surg. 2008;46(5):373–432.

    Google Scholar 

  4. Huang CS, Hess DT, Lichtenstein DR. Successful endoscopic management of postoperative GI fistula with fibrin glue injection: report of two cases. Gastrointest Endosc. 2004;60(3):460–3.

    Article  Google Scholar 

  5. Okamoto K, Watanabe Y, Nakachi T, et al. The use of autologous fibrin glue for the treatment of postoperative fecal fistula following an appendectomy: report of a case. Surg Today. 2003;33(7):550–2.

    PubMed  Google Scholar 

  6. Lamont JP, Hooker G, Espenschied JR, Lichliter WE, Franko E. Closure of proximal colorectal fistulas using fibrin sealant. Am Surg. 2002;68(7):615–8.

    PubMed  Google Scholar 

  7. Fazio VW, Coutsoftides T, Steiger E. Factors influencing the outcome of treatment of small bowel cutaneous fistula. World J Surg. 1983;7(4):481–8.

    Article  CAS  Google Scholar 

  8. Hollington P, Mawdsley J, Lim W, Gabe SM, Forbes A, Windsor AJ. An 11-year experience of enterocutaneous fistula. Br J Surg. 2004;91(12):1646–51.

    Article  CAS  Google Scholar 

  9. Galland RB, Spencer J. Natural history and surgical management of radiation enteritis. Br J Surg. 1987;74(8):742–7.

    Article  CAS  Google Scholar 

  10. Li VKM, Wexner SD, Pulido N, Wang H, Jin HY, Weiss EG, et al. Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure? Surg Endosc. 2009;23(11):2459–65.

    Article  Google Scholar 

  11. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105–13.

    Article  CAS  Google Scholar 

  12. Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222(2):120–7.

    Article  CAS  Google Scholar 

  13. Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs. ulcerative colitis. Arch Surg. 2002;137(6):690–4.

    Article  Google Scholar 

  14. Sugerman HJ, Sugerman EL, Meador JG, Newsome Jr HH, Kellum Jr JM, DeMaria EJ. Ileal pouch anal anastomosis without ileal diversion. Ann Surg. 2000;232(4):530–41.

    Article  CAS  Google Scholar 

  15. Heuschen UA, Hinz U, Allemeyer EH, et al. Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg. 2002;235(2):207–16.

    Article  Google Scholar 

  16. Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204(5):956–62.

    Article  Google Scholar 

  17. Marusch F, Koch A, Schmidt U, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum. 2002;45(9):1164–71.

    Article  Google Scholar 

  18. Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Jarvinen HJ. A randomised study of colostomies in low colorectal anastomoses. Eur J Surg. 1997;163(12):929–33.

    CAS  PubMed  Google Scholar 

  19. Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg. 1998;85(8):1114–7.

    Article  CAS  Google Scholar 

  20. Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999;230(4):544–52.

    Article  CAS  Google Scholar 

  21. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.

    Article  CAS  Google Scholar 

  22. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2004;92(2):211–6.

    Article  Google Scholar 

  23. Merad F, Hay JM, Fingerhut A, et al. Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery. 1999;125(5):529–35.

    Article  CAS  Google Scholar 

  24. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg. 1999;229(2):174–80.

    Article  CAS  Google Scholar 

  25. van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JFM, et al. The Dutch multicenter experience of the Endo-Sponge treatment foe anastomotic leakage after colorectal surgery. Surg Endosc. 2009;23:1379–83.

    Article  CAS  Google Scholar 

  26. Turnbull Jr RB. Pull-through resection of the rectum, with delayed anastomosis, for cancer or Hirschsprung’s disease. Surgery. 1966;59:498–502.

    PubMed  Google Scholar 

  27. Cutait DE, Cutait R, Ioshimoto M, et al. Abdominoperineal endoanal pull-through resection. A comparative study between immediate and delayed colorectal anastomosis. Dis Colon Rectum. 1985;28:294–9.

    Article  CAS  Google Scholar 

  28. Bacon HE. Present status of the pull-through sphincter-preserving procedure. Cancer. 1971;28:196–203.

    Article  CAS  Google Scholar 

  29. Remzi FH, El Gazzaz G, Kiran RP, et al. Outcomes following Turnbull–Cutait abdominoperineal pull-through compared with coloanal anastomosis. Br J Surg. 2009;96:424–9.

    Article  CAS  Google Scholar 

  30. Di Giorgio P, De Luca L, Rivellini G, Sorrentino E, D’amore E, De Luca B. Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: a prospective comparison study of two balloon types. Gastrointest Endosc. 2004;60(3):347–50.

    Article  Google Scholar 

  31. Suchan KL, Muldner A, Manegold BC. Endoscopic treatment of postoperative colorectal anastomotic strictures. Surg Endosc. 2003;17(7):1110–3.

    Article  CAS  Google Scholar 

  32. Hollabaugh Jr RS, Steiner MS, Sellers KD, Samm BJ, Dmochowski RR. Neuroanatomy of the pelvis: implications for colonic and rectal resection. Dis Colon Rectum. 2000;43(10):1390–7.

    Article  Google Scholar 

  33. Walsh PC, Schlegel PN. Radical pelvic surgery with preservation of sexual function. Ann Surg. 1988;208(4):391–400.

    Article  CAS  Google Scholar 

  34. Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010;(2):CD007511.

    Google Scholar 

  35. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996;182(6):495–502.

    CAS  PubMed  Google Scholar 

  36. Masui H, Ike H, Yamaguchi S, Oki S, Shimada H. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum. 1996;39(10):1140–5.

    Article  CAS  Google Scholar 

  37. Lindsey I, Mortensen NJ. Iatrogenic impotence and rectal dissection. Br J Surg. 2002;89(12):1493–4.

    Article  CAS  Google Scholar 

  38. Lindsey I, George B, Kettlewell M, et al. Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum. 2002;45(6):727–32.

    Article  Google Scholar 

  39. daSilva GM, Hull T, Roberts PL, Ruiz DE, Wexner SD, Weiss EG, et al. The effect of colorectal surgery in female sexual function, body image, self esteem and general health: a prospective study. Ann Surg. 2008;248(2):266–72.

    Article  Google Scholar 

  40. Gorgun E, Remzi FH, Goldberg JM, et al. Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients. Surgery. 2004;136(4):795–803.

    Article  Google Scholar 

  41. Olsen KO, Joelsson M, Laurberg S, Oresland T. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Br J Surg. 1999;86(4):493–5.

    Article  CAS  Google Scholar 

  42. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg. 2000;231(4):529–37.

    Article  CAS  Google Scholar 

  43. Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg. 1983;145(1):176–82.

    Article  CAS  Google Scholar 

  44. Biondo S, Pares D, Mora L, Marti RJ, Kreisler E, Jaurrieta E. Randomized clinical study of gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg. 2003;90(5):542–6.

    Article  CAS  Google Scholar 

  45. Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg. 2002;236(1):1–6.

    Article  Google Scholar 

  46. Chen SC, Lin FY, Lee PH, Yu SC, Wang SM, Chang KJ. Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg. 1998;85(12):1692–4.

    Article  CAS  Google Scholar 

  47. Becker JM, Dayton MT, Fazio VW, et al. Prevention of post-operative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg. 1996;183(4):297–306.

    CAS  PubMed  Google Scholar 

  48. Fazio VW, Cohen Z, Fleshman JW, et al. Adhesion Study Group. Reduction in adhesive small bowel obstruction by Seprafilm® adhesion barrier after intestinal resection. Dis Colon Rectum. 2006;48:1–9.

    Google Scholar 

  49. Nivatvongs S, Fang DT. The use of thumbtacks to stop massive presacral hemorrhage. Dis Colon Rectum. 1986;29(9):589–90.

    Article  CAS  Google Scholar 

  50. Stolfi VM, Milsom JW, Lavery IC, Oakley JR, Church JM, Fazio VW. Newly designed occluder pin for presacral hemorrhage. Dis Colon Rectum. 1992;35(2):166–9.

    Article  CAS  Google Scholar 

  51. Remzi FH, Oncel M, Fazio VW. Muscle tamponade to control presacral venous bleeding: report of two cases. Dis Colon Rectum. 2002;45(8):1109–11.

    Article  Google Scholar 

  52. Cosman BC, Lackides GA, Fisher DP, Eskenazi LB. Use of tissue expander for tamponade of presacral hemorrhage. Report of a case. Dis Colon Rectum. 1994;37(7):723–6.

    Article  CAS  Google Scholar 

  53. Losanoff JE, Richman BW, Jones JW. Cyanoacrylate adhesive in management of severe presacral bleeding. Dis Colon Rectum. 2002;45(8):1118–9.

    Article  Google Scholar 

  54. Xu J, Lin J. Control of presacral hemorrhage with electrocautery through a muscle fragment pressed on the bleeding vein. J Am Coll Surg. 1994;179(3):351–2.

    CAS  PubMed  Google Scholar 

  55. Metzger PP. Modified packing technique for control of presacral pelvic bleeding. Dis Colon Rectum. 1988;31(12):981–2.

    Article  CAS  Google Scholar 

  56. Rau HG, Mittelkotter U, Zimmermann A, Lachmann A, Kohler L, Kullmann KH. Perioperative infection prophylaxis and risk factor impact in colon surgery. Chemotherapy. 2000;46(5):353–63.

    Article  CAS  Google Scholar 

  57. Platell C, Hall JC. The prevention of wound infection in patients undergoing colorectal surgery. J Hosp Infect. 2001;49(4):233–8.

    Article  CAS  Google Scholar 

  58. Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg. 2004;91(9):1125–30.

    Article  CAS  Google Scholar 

  59. Platell C, Hall J. What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum. 1998;41(7):875–82.

    Article  CAS  Google Scholar 

  60. Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2003;(2):CD001544.

    Google Scholar 

  61. Khurrum BM, Hua ZR, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol. 2002;6(3):159–64.

    Article  Google Scholar 

  62. Schechter S, Eisenstat TE, Oliver GC, Rubin RJ, Salvati EP. Computerized tomographic scan-guided drainage of intra-abdominal abscesses. Preoperative and postoperative modalities in colon and rectal surgery. Dis Colon Rectum. 1994;37(10):984–8.

    Article  CAS  Google Scholar 

  63. Benoist S, Panis Y, Pannegeon V, et al. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg. 2002;184(2):148–53.

    Article  Google Scholar 

  64. Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg. 2002;137(7):845–9.

    Article  Google Scholar 

  65. Pollard CW, Nivatvongs S, Rojanasakul A, Ilstrup DM. Carcinoma of the rectum. Profiles of intraoperative and early post-operative complications. Dis Colon Rectum. 1994;37(9):866–74.

    Article  CAS  Google Scholar 

  66. Rosen L, Veidenheimer MC, Coller JA, Corman ML. Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum. 1982;25(3):202–8.

    Article  CAS  Google Scholar 

  67. Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg. 1992;16(3):478–85.

    Article  CAS  Google Scholar 

  68. Nissan A, Guillem JG, Paty PB, et al. Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum. 2001;44(1):27–35.

    Article  CAS  Google Scholar 

  69. Silen W, Glotzer DJ. The prevention and treatment of the persistent perineal sinus. Surgery. 1974;75(4):535–42.

    CAS  PubMed  Google Scholar 

  70. Wang JY, Huang CJ, Hsieh JS, Huang YS, Juang YF, Huang TJ. Management of the perineal wounds following excision of the rectum for malignancy. Gaoxiong Yi Xue Ke Xue Za Zhi. 1994;10(4):177–81.

    CAS  PubMed  Google Scholar 

  71. Hay JM, Fingerhut A, Paquet JC, Flamant Y. Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research. Eur J Surg. 1997;163(3):199–206.

    CAS  PubMed  Google Scholar 

  72. Rice ML, Hay AM, Hurlow RH. Omentoplasty in abdominoperineal resection of the rectum. Aust N Z J Surg. 1992;62(2):147–9.

    Article  CAS  Google Scholar 

  73. Ferguson CM. Use of omental pedicle grafts in abdominoperineal resection. Am Surg. 1990;56(5):310–2.

    CAS  PubMed  Google Scholar 

  74. Smith SR, Swift I, Gompertz H, Baker WN. Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage. Br J Surg. 1988;75(10):1012–5.

    Article  CAS  Google Scholar 

  75. Moreaux J, Horiot A, Barrat F, Mabille J. Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer. Am J Surg. 1984;148(5):640–4.

    Article  CAS  Google Scholar 

  76. Baudot P, Keighley MR, Alexander-Williams J. Perineal wound healing after proctectomy for carcinoma and inflammatory disease. Br J Surg. 1980;67(4):275–6.

    Article  CAS  Google Scholar 

  77. Irvin TT, Goligher JC. A controlled clinical trial of three different methods of perineal wound management following excision of the rectum. Br J Surg. 1975;62(4):287–91.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Disease, Cleveland Clinic, Cleveland, OH, USA

    David W. Dietz MD

Authors
  1. David W. Dietz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Colon and Rectal Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA

    David E. Beck MD, FACS, FASCRS

  2. Department of Colorectal Surgery, Lahey Clinic, Tufts University School of Medicine, Burlington, Massachusetts, USA

    Patricia L. Roberts MD, FACS, FASCRS

  3. Section of Colon and Rectal Surgery, Rush Medical Center, Chicago, Illinois, USA

    Theodore J. Saclarides MD, FACS, FASCRS

  4. Department of Surgery, Spectrum Health, Grand Rapids, Michigan, USA

    Anthony J. Senagore MD, FACS, FASCRS

  5. Department of Surgery, UCI Medical Center, Orange, California, USA

    Michael J. Stamos MD, FACS, FASCRS

  6. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA

    Steven D. Wexner MD, FACS, FASCRS, FRCS, FRCS(Ed)

Rights and permissions

Reprints and permissions

Copyright information

© 2011 ASCRS (American Society of Colon and Rectal Surgeons)

About this chapter

Cite this chapter

Dietz, D.W. (2011). Postoperative Complications. In: Beck, D.E., Roberts, P.L., Saclarides, T.J., Senagore, A.J., Stamos, M.J., Wexner, S.D. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1584-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1584-9_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1581-8

  • Online ISBN: 978-1-4419-1584-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics