Complications occur in all branches of surgery and require vigilance in their detection. In many cases anticipating the likely complications and appropriate avoidance will minimise their occurrence. For the purposes of the exam the important principles to appreciate are:

• The anatomical principles that underpin complications
• The physiological and biochemical derangements that occur
• The most appropriate diagnostic modalities to utilise
• The principles which underpin their management

This is clearly a very broad area and impossible to cover comprehensively. There is considerable overlap with other topic areas within the website.

Avoiding complications

Some points to hopefully avert complications:

• World Health Organisation checklist- now mandatory prior to all operations
• Prophylactic antibiotics - right dose, right drug, right time.
• Assess DVT/ PE risk and ensure adequate prophylaxis
• MARK site of surgery
• Use tourniquets with caution and with respect for underlying structures
• Remember the danger of end arteries and in situations where they occur avoid using adrenaline containing solutions and monopolar diathermy.
• Handle tissues with care- devitalised tissue serves as a nidus for infection
• Be very wary of the potential for coupling injuries when using diathermy during laparoscopic surgery
• The inferior epigastric artery is a favorite target for laparoscopic ports and surgical drains!

Anatomical principles

Understanding the anatomy of a surgical field will allow appreciation of local and systemic complications that may occur. For example nerve injuries may occur following surgery in specific regions the table below lists some of the more important nerves to consider and mechanisms of injury