Injury to the Spleen
- Prevention through subtle preparation
- hemostatic measures (coagulation, hemostatics)
- Splenectomy as a last resort
Esophageal/Stomach Wall Injury
- Prevention through subtle preparation
- Estimate removal of the hernia sac in large hernias, if the risk is too great, only detach the hernia sac from the diaphragmatic crura and leave the hernia sac in the mediastinum.
- Diagnosis possible through intraoperative blue test,
Therapy by suturing the defect and ideally covering with the wrap. - if necessary, intraoperative endoscopic control
- in case of esophageal lesion: preferably Nissen wrap and avoid additional sutures on the esophagus
Bleeding
- Short gastric arteries:
- Possible complication when transecting the short gastric arteries for stomach fundus mobilization.
- Hemostasis can be challenging with poor exposure and significant visceral obesity.
- Diaphragmatic veins:
- In close proximity to the hiatus,
- Hemostasis can also be challenging.
- Aorta:
- Runs behind the hiatus,
- an injury is theoretically possible.
- Pneumothorax
- Due to injury to the parietal pleura during mediastinal preparation.
- In a stable patient initially without consequence, if ventilation pressure increases or oxygenation worsens, initially reduce intra-abdominal pressure or directly place an intraoperative chest drain.
- At the end of the operation, ensure good lung ventilation through manual ventilation with open trocars.
- After releasing the pneumoperitoneum, rapid resolution of the pneumothorax is expected.