林巧文1 林子平12 黃志賢12
V-Loc Associated Intestinal Obstruction: A Noteworthy Cause of Postoperative Ileus After Robotic Assisted Radical Prostatectomy
Chyau-Wen Lin1, Tzu-Ping Lin12, William JS Huang12
1Department of Urology, Taipei Veterans General Hospital, Taiwan
2Department of Urology, College of Medicine and Shu-Tien Urological Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
Postoperative ileus is one of the postoperative complications of radical prostatectomy. Along with the progressive adoption of the robotic assistance approach, the incidence is lower than the conventional radical prostatectomy. We here presented a case of ileus after robotic assisted radical prostatectomy (RaRP), which was caused by barbed suture material.
A 79-year-old male with a history of bilateral inguinal hernia status post bilateral total extraperitoneal laparoscopic hernia repair. He also had suffered from volvulus and received laparoscopic sigmoid resection years ago. The patient was diagnosed with localized prostate cancer by Holmium laser enucleation of the prostate and underwent RaRP in our hospital. A conventional robotic approach was used, and the procedure was carried out smoothly, of note, the peritoneum was closed with barbed sutures to insulate the previously placed mesh from intra-abdominal content. The patient suffered from a period of persistent abdominal bloating with pain during the early postoperative course.. Abdominal CT was arranged to study possible mechanical obstruction or acute abdomen, and dilated small bowel with suspicious transition zone at left lower abdomen was noted. After conservative treatment with NG decompression, he gradually recovered and was discharged with sub-optimal oral intake.Progressive abdominal fullness without pain were noted after discharge. Due to persistent symptoms, Repeated CT scan revealed progressive dilation of bowel loops with transition zone, compatible with mechanical obstruction. After consulting GS doctor, an emergent explore laparotomy was performed on the same night. The small intestine was attached to the barbed surface of the V-loc used for re-peritonization, resulting in bowel obstruction. Enterolysis with intestinal serosa repair was performed. The rest of the admission was uneventful, and the patient was discharged from our ward. During the outpatient department, there were no recurring signs or symptoms of bowel obstruction.