Although anorectal surgery is generally regarded as a minor operation compared to abdominal surgery, cardiothoracic surgery, and craniotomy, due to the special location and highly polluted local environment, there are still related complications after anorectal surgery. Here, let me introduce you.
1 Anesthesia accident
Anesthetic accidents mainly include anesthetic poisoning reaction and anesthetic allergy. The incidence of anesthesia poisoning reaction was 0.2%. The main performance is divided into three levels. Mild poisoning reactions are mainly manifested as dizziness, increased pulse rate, drowsiness, and blood pressure; moderate poisoning reactions are manifested as irritability, nausea, vomiting, accompanied by hypoxia and other symptoms; severe poisoning reactions are also manifested in muscles Convulsions, convulsions. Toxic reactions should be dealt with in time, oxygen inhalation (to keep the respiratory tract unobstructed), pressure stabilization, antispasmodic treatments. Improper treatment can have fatal consequences.
Allergic reactions to anesthesia are rare. The patient presents with urticaria, collapse, cyanosis, convulsions, laryngeal edema, etc., which may be life-threatening. Anti-allergic treatment should be given promptly.
Treatment measures: To avoid anaesthetic toxicity and allergic reactions. The doctor will carefully ask if there is a history of allergies before the operation. Before surgery, nurses will be required to open intravenous access to facilitate rescue medication; regular oxygen inhalation to avoid hypoxemia.
2 Cardiovascular accident
Surgery is a kind of stress response, which can sometimes induce insidious cardiovascular and cerebrovascular diseases, especially if it is combined with uncontrolled hypertension or heart disease. It may cause cerebral hemorrhage or myocardial infarction.
Treatment measures: In order to avoid this situation, the patient needs to check the electrocardiogram before the operation, and if necessary, perform cardiac color ultrasound and myocardial enzyme examination.
Three intraoperative bleeding
There will definitely be bleeding during the operation, but there is still bleeding after the operation. Some patients feel that it cannot be accepted because many hemorrhoids patients are hospitalized because of blood in the stool. In fact, postoperative bleeding is a very common complication, which can be divided into different situations. Because most of the anorectal surgery are open incisions, that is, no sutures are made after the incision, so that there will be a little blood and not a lot of stimulation on the wound during defecation, so the patient does not need to be nervous. However, in some cases, such as shedding of hemorrhoids and a large amount of bleeding caused by the shedding of staples, it needs to be dealt with in time, otherwise it may cause shock and even life-threatening. This kind of bleeding is often in the hemorrhoid shedding period, 7-15 days after surgery. Therefore, in many cases, the doctor will recommend to observe this time before leaving the hospital.
Treatment measures: If severe bleeding occurs during hospitalization, doctors and nurses should be notified in time. If it occurs after discharge, they should be treated at the nearest place in time. When the condition is stable, transfer to a more qualified hospital for treatment.
4. Wound pain Postoperative pain in anorectal department is the main reason why many people fear surgery. The pain caused by the following aspects: 1. The wound is too large and the tissue defect is too much, such as anal fistula, annular mixed hemorrhoids, etc.; 2. Perianal tissue edema; 3. Re-infection after surgery. However, the pain is usually the heaviest in the first week and will gradually decrease afterwards. Treatment measures: Methylene blue can be injected into the wound for long-acting pain relief; diclofenac sodium suppository can be plugged for pain relief; pain relief tablets or intramuscular injection of analgesics can be used for pain relief. You can take a bath more, and infrared radiation can relieve pain.
5 Poor stool
The most important thing after anorectal surgery is to maintain a smooth stool. Once a day, the stool is soft, which is the best condition. If the stool is not smooth, if the patient works hard, it is easy to cause edema of the anal margin skin, aggravate the pain, and increase the risk of bleeding. Therefore, after the operation, especially if the wound is not completely healed and discharged early, it is necessary to keep the stool smooth.
Treatment measures: you can take orally moisturizing and laxative drugs, such as docusate sodium tablets, oral intestinal regulators, such as bifidobacteria quadruple viable bacteria tablets to improve stool; drink plenty of water and eat a high-fiber light diet ( Such as all kinds of vegetables), eat bananas, pears, dragon fruits and other laxative foods, and avoid spicy foods.
Six wound edema
The ultimate goal of anorectal surgery is to protect the normal function of the anus. We should not pursue an excessively flat anus. If all hemorrhoids are completely removed, it will lead to postoperative anal stenosis. Therefore, in the operation of circular mixed hemorrhoids, the normal skin and mucous membrane bridge must be preserved. However, it is this preserved tissue that may cause postoperative anal skin edema, which is also normal. The smaller edema will gradually decrease during the recovery process, and finally restore its flatness; the larger edema may still remain after subsiding, forming skin tag-like external hemorrhoids.
Treatment measures: In order to avoid aggravation of edema, try to avoid struggling to defecate after surgery. If the bowel movement does not come out, you can choose to clean the enema or use Kaisailu for treatment.
Seven postoperative infection
From a proportional point of view, the possibility of infection after anorectal surgery is less, which is related to the openness of the wound; but if closed surgery (that is, the wound is sutured), although the wound will heal quickly, the infection The risk will increase exponentially.
Treatment measures: Antibiotics are generally used prophylactically; if infection does develop, wounds should be expanded and drained in time to avoid further aggravation of infection.
8. The wound heals slowly
Wounds in the anorectal department cannot heal within one or two days. Some hospitals may arrange to be discharged 3-5 days after surgery due to tight beds. However, wound healing still takes a long time, usually about 4 weeks. If the wound is too large or deep, the healing time may be longer. A very small number of patients even delayed 2 to 3 months before healing.
Treatment measures: wounds should be changed regularly in time, and during the recovery process, they should be reviewed regularly. Some operations, especially mixed hemorrhoids PPH surgery, are prone to anastomotic stricture, and should be actively reviewed. . The stenosis can be cured by the treatment of anal expansion in the early stage. Once the scar has formed and aged, it cannot be expanded and can only choose scar incision at the stenosis.
Nine postoperative recurrence
Many anorectal diseases are treated symptomatically, such as bleeding and prolapse of hemorrhoids. After surgical treatment, hemorrhoids can be removed to achieve the purpose of stopping bleeding and solving prolapse. However, many anorectal diseases are lifestyle-related diseases and may recur if they are not paid attention after surgery. It is not like appendicitis. After the cut, you will never get appendicitis again, because the appendix cannot grow back. However, if hemorrhoids, anal fistulas, anal fissures and other diseases have undergone surgery, there is still a possibility of recurrence. Only through active prevention can the risk of recurrence be reduced.
Treatment measures: The prevention mainly includes the following aspects: 1. Squat shortly after defecation; do not read the newspaper during defecation; 2. Proper activities; cannot sit for a long time; the driver is a high incidence of hemorrhoids because of long-term sedentary. 3. Spicy and irritating food should be properly controlled, especially when anorectal diseases have symptoms.
Ten postoperative urine retention
Urinary retention is a common complication after surgery. It is related to anesthesia, too much dressing in the wound after surgery, and also related to severe postoperative pain.
Treatment measures: When urinary retention occurs, hot compress, spacer moxibustion, acupuncture and other treatments can be used, neostigmine muscle or acupoint injection can also be used; when these methods are not effective, urinary catheterization can be used for treatment.
11 Anal bulge
Anal bulging is a manifestation of local inflammation. PPH stapler often occurs after surgery, and mixed hemorrhoids external peeling and internal ligation may also occur when the ligation thread does not fall off; when anal fistula patients undergo suture treatment, anal bulge may also occur due to the stimulation of the rubber band. The duration of anal bulging will not be long, 3-5 days, and very few may be more than 10 days.
Treatment measures: Diclofenac sodium can be used to embolize the anus for relief, or metronidazole retention enema can be used for relief.
Twelve rectovaginal fistula
This complication is rare but very troublesome. It means that the wall of the rectum and the wall of the vagina pass through, and the stool is discharged from the approach passage through the fistula. Patients with this complication are painful. No such complications have occurred in our department.
Treatment measures: Operate again after the inflammation period.
13 Anal incontinence
The probability of this occurrence is very low, but if it is a high complex anal fistula, when the internal opening is above the anorectal ring, the traditional thread-hanging method may damage the anal function and reduce the anal sphincter ability.
Treatment measures: surgical treatment again.