Ch.8 - Post-op Complications

Question 1

Frailty phenotype is best characterized by what things?

Answer 1

Unintentional weight loss
Decreased energy
Decrease in activity and strength

Question 2

What is the long term incidence of bowel obstruction after abdominal/pelvic surgery?

Answer 2

12-17% within 2 years

Question 3

What is the documented rate of iatrogenic ureteral injury after colorectal surgery?

Answer 3

0.3-1.5%

Question 4

What factors are indicative of increased risk of ureteral injury?

Answer 4

Female
Increased EBL
reoperation

Question 5

What do you do for a posterior bladder injury?

Answer 5

You have to inspect for ureteral injury.

1) mobilize the space of Retzius
2) anterior cystotomy and get a full exposure of the trigone and interior of the bladder
3) administer indigo Carmine to aid in ureteral orifice identification
4) posterior repair is then performed

Question 6

What to do for small extraperitoneal bladder injuries?

Answer 6

7-14 days of Foley catheter

Question 7

What to do for a simple urethral injury?

What to do for extensive urethral injury?

What if repair is not feasible?

Answer 7

Primary repair in two layers with absorbable suture

Local tissue flap

Suprapubic catheter and repair can be performed several months later

Question 8

What are the stages of rectourethral fistula?

Answer 8

Stage I: low (<4 cm from anal verge, non irradiated)
Stage II: high (>4 cm from anal verge, non irradiated)
Stage III: small (<2 cm diameter, irradiated)
Stage IV: large (>2 cm diameter, irradiated)
Stage V: large (ischial decubitus fistula)

Question 9

Fecal diversion is recommended for what stages of rectourethral fistulas?

Answer 9

Stages 3-5: any radiated + ischial decubitus fistula

Question 10

What is the incidence of post-op bladder dysfunction after APR vs. LAR?

These procedures most commonly result in denervation of what? Which leads to what?

Answer 10

50% and 15-25%

Denervation of parasympathetic detrusor resulting in impaired contractility of the bladder

Question 11

What is the pre-op and post-op infertility rate after restorative proctocolectomy for ulcerative colitis?

Answer 11

Pre-op: 15%

Post-op: 48%

Question 12

What is a low anterior resection syndrome?

Answer 12

Fecal incontinence, urgency, frequent BMs, clustering of BMs

Question 13

How does pre-op radiation before LAR affect quality of life post-op?

Answer 13

Slower recovery from defecation problems
Negative effect on sexual functioning in males and females
More ejaculation disorders erectile functioning