Management of Complications of Gastro-Intestinal Surgery

The overall chance for patients admitted to a surgical ward to encounter a severe adverse effect of their treatment ranges from 10 to 50%, depending on the type of gastro-intestinal surgery. Some of these complications are rather frequent, but with only a minimal effect on the immediate outcome of treatment, whereas other complications are infrequent, but have a dramatic effect; In many cases, re-interventions are needed. Prevention of complications can be achieved by either a selection of patients or procedures, or by a concentration of knowledge and experience. Thus, patient's co-morbidity should be assessed before selecting for invasive surgery, and alternative procedures should be offered to elderly, frail and malnourished patients. Modern imaging techniques can prevent unnecessary laparotomies, and diagnostic laparoscopy can prevent more invasive laparotomies. Moreover, there is no good evidence that more extensive surgery has a better success rate. Furthermore, pre-operative measures can be taken, such as pre-operative enteral and parenteral nutrition, internal biliary drainage or antibiotic prophylaxis. Last but not least, the concentration of knowledge and experience in specialized centers also seems to influence the outcome of surgery. This publication collects the papers presented and cases discussed during the postgraduate course under the auspices of EDS and ISDS held during the United European Gastroenterology Week, Amsterdam, in 2001. It will be a good reference work for all gastro-intestinal surgeons.