HEGAZY SURGERY

1. M O H A M E D A N A D A
A S S I S T A N T P R O F E S S O R G E N E R A L S U R G E R Y
C O L O R E C T A L U N I T
A I N S H A M S U N I V E R S I T Y
COMPLICATIONS OF
RECTAL CANCER
TREATMENT

2. CLASSIFICATIONS
• According to the type of the treatment
radiation related, chemotherapy related and surgery
related.
• Surgical complications: According to timing
intraoperative, postoperative ( early, late).
• Surgical complications: Anatomical classification
abdominal , pelvic, perineal/ vascular, neurological,
bowel, urological, genital, sexual, wound related

3. BLEEDING
Intraoperative, postoperative
Bleeding, hematoma
• Inferior mesenteric artery , vein , tributaries
• Splenic injury
• Middle colic v …. SMV
• Omental vessel
• Gonadal v , uterine v
• iliac vs (site)
• Presacral venous plexus
• Prostatic plexus
• Lateral ligaments
• Perineal vessels.

4. BLOOD SUPPLY

5. BLEEDING
• Manifestation of bleeding
• Hematoma low grade fever, pulse, pelvic, jaundice,
sepsis
• Laparoscopic, open
• Sealing devices
• Abdominal, pelvic
• Precautions: proper planes of dissection, vascular
control from the start, identify the major vascular
supplies, don't hesitate to reopen

6. BOWEL ISCHEMIA
• Technical
MCA>IMA arch
Tension over the proximal end
Taking the mesentery off the colon
Twist of the proximal end at the anastomotic site
• Atherosclerosis, radiation arteritis
Early: peritonitis, leakage, burst abdomen, wound
dehiscence, gangrene of the stoma
Late: anastomotic stricture , complete disruption of the
anastomosis

7. LEAKING
• Radiological, minor, moderate, severe leak.
• Early: major to moderate, intraperitoneal collection, leak
from the wound, pelvic abscess, delay of the intestinal
movement, pyrexia/ role of radiology and examination.
• Late: moderate to minor discharge, fistula, pelvic
suppuration, after closure of the proximal stoma.
• Management according to the degree.
• Staplers versus hand sewn anastomosis.
• CT scan, dye study

8. CONSTIPATION
• Constipation versus obstruction
• Stricture at the anastomotic site
• missed Synchronous lesion
• Adhesions
• twist at the anastomotic site
• Side to end anastomosis, huge pouch (obstructed
defecation).
• IO (adhesions, internal hernia, loops inside perineal
defect, paralytic).

9. STOOL INCONTINENCE
• Incontinence versus constipation
• Incontinence true or false
• Ultra low resection, perineal approach
• Intersphincteric resection
• Coloplasty versus pouch for poor reservoir
• Selection of patients optimal for ultra low resection
• Absent intrinsic reflex
• Coloanal anastomosis, pull through technique

11. WOUND COMPLICATIONS
• Infection (abdominal, perineal)
• Dehiscence ( abdominal perineal)
• Complete dehiscence (bowel from abdomen, perineum)
• Fistulas (abdominal, perineal)
• Complications of stoma (soiling, hernia, retraction,
gangrene, stenosis, recurrence)
• Late incisional hernia
• Laparoscopic and open

12. URINARY, GENITAL, SEXUAL
• Injury to ureter (site)
• Urinary bladder injury
• Urethral injury (site)
• Atonic bladder
• Impotence, loss of erection, ejaculation (autonomic
innervation injury)
• Injury to genital organs (vagina, seminal vesicles,
prostate)

13. NERVE INJURY
• Autonomic nerve injury
bladder dysfunction
sexual dysfunction
• Cauda equina
• Peroneal nerve
• Femoral nerve

14. AUTONOMIC NERVE SUPPLY

15. RADIOTHERAPY
• Preoperative delay, diarrhea, bleeding
stationary, progressive
fibrosis, arteritis
ovaries
• postoperative ovaries, small intestinal

16. CHEMOTHERAPY AND TARGETED
THERAPIES
• Neoadjuvant, adjuvant therapy
• Vomiting, diarrhea, electrolyte disturbance, GIT upset,
gastric erosions, entropathy, neuropathy, bone marrow
depression, jaundice, skin lesions, cardiovascular.
• Poor response

17. NOTES
• Proper surgical procedure means optimal result
• Alternatives to stapled anastomosis
• Non touch
• Individualize the protocol
• MDT
• Importance of margins
• Importance of preoperative staging