Most operations fall into the category of “elective”, “intermediate elective” and “straightforward emergency”. In the first two categories, the patients are fairly in good fluid and electrolyte and nutritional equilibrium, but in the last category, they may not be so. Major operations, especially involving the gastrointestinal tract pose particular problems of fluid management whether the operation is elective or an emergency. In any case, knowledge of the intravenous fluids and the fluids used for nutritional buildup of a patient and their administration, both before, during and after surgery becomes very important for a surgeon's successful management of an operated patient. Careful preoperative and postoperative assessment of patients having major surgery is essential so that the problems can be recognized early. In spite of the best of preoperative preparation and the operative techniques, complications do occur due to various causes.
Patients admitted to a surgical ward and having undergone a gastrointestinal surgery, have more than 10 percent chance to encounter severe adverse effect of the surgical treatment. For some types of gastrointestinal surgery, the risk of complication can be as high as 50 percent. The complications vary from a superficial wound infection to anastomotic leaks to incisional hernias. Of these, the anastomotic leaks carry the extreme risk of progressing to generalized peritonitis, septicaemia and death—worst scenario indeed. It is proved beyond doubt that the complication rate is much more in cancer patients, when compared to those with benign disease.
Iatrogenic injuries to the organ involved in the specified surgery or to the adjacent organ also play a large role in creating complications in the postoperative period.
Prevention is the next step in the management of complications. Patient's co-morbidity is a clear risk factor for complications. Nutritional corrective measures, modern imaging techniques, both diagnostic and therapeutic, such as helical CT scan, ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP)-aided decompressive procedures are able to prepare the patients well before surgery, thus reducing the morbidity and mortality due to complications in the postoperative period.
Whatever said and done, management of complications after gastrointestinal surgery needs knowledge, tact and patience and complete understanding on the scientific basis, for success at the end of the road.