What are the possible complications of proctitis and anusitis surgery?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Wound infection may develop with a proctectomy. It is not uncommon for the perineal wound to separate slightly during the immediate postoperative period. If any discharge or erythema is noted around the wound, especially if there was some tension upon closure, opening the wound earlier rather than later is prudent. Addressing the open wound with wet-to-dry dressing changes routinely allows the wound to close without incident.

Sexual dysfunction can occur when the pelvic nerves are injured. The best way to deal with this complication is to be cognizant of the possibility prior to surgery and avoid it. Once it occurs, very little can be done to help the nerves. The role of medications such as sildenafil remains unclear, though sildenafil has been reported to help.

As with sexual dysfunction, every effort should be made to avoid urinary dysfunction in the operating room.

Avoiding ureteral injury by remaining cognizant of the ureteral anatomy is a paramount consideration. Once the injury occurs, recognizing this at the time of operation clearly is best. The repair is dictated by where the injury occurs in the ureter. Consultation with a urologist is prudent.

In a few cases, presacral bleeding has been reported to progress to death. Clearly, avoidance is the best way to deal with this complication. If it does occur in the midst of the procedure, cautery or pressure generally does not stop true presacral bleeding from the pelvic veins. The usual method of stopping the bleeding is to use a thumbtack. A muscle pledget is also a clever way to cauterize the bleeding. Take a piece of rectus muscle, apply it to the bleeding site, and cauterize the muscle on a high coagulation setting.


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