達文西腹腔鏡攝護腺全切除手術後的引流管引起腸阻塞
蘇奕瑋1、張瓈文2、李建儀2、裘坤元2、洪晟鈞2
1台中榮民總醫院教學部
2台中榮民總醫院外科部泌尿外科
Surgical drain related bowel obstruction after Robotic-assisted Laparoscopic radical prostatectomy
Yi-Wei Su1, Li-Wen Chang2, Jian-Ri Li2, Kun-Yuan Chiu2, Sheng-Chun Hung2
1Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
2Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Abstract
Drainage tubes have been widely used in different operations aimed for many benefits including reducing postoperative infection, fluid or air accumulation. In Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy and Pelvic Lymphadenectomy, pelvic drain may evacuate an unanticipated urine leak or lymphatic fluid collection. Common Postoperative Complications of RARP & BPLND includes Massive blood loss, Intraperitoneal Urine Leak, Bladder Neck Stricture, Pelvic Node Dissection Complications.
We are reporting two prostate cancer cases who had rare postoperative complications. Both of them received robotic-assisted laparoscopic radical prostatectomy + BPLND and developed ileus and bowel obstruction. Series follow up images suggested bowel obstruction which may related to drainage tube. No evidence of urine leakage nor intestine perforation base on drainage fluid analysis. We performed explore laparoscopic surgery in the first and found drainage tube kinking with terminal ileum and adhesion band. Drainage tube was removed and patient recovery well in the following days. In the second case, the patients got bowel obstruction for four days after operation. Base on the experience of first case and drainage fluid survey, we remove drainage tube on the fourth day morning and patient got dramatic recovery with flatus and stool passage in the afternoon. Both of them recovered well. To best of our knowledge, despite there’s some case reports about drainage tube ileus in colorectal and bowel surgery, we reported the first cases of small bowel obstruction as a complication arising from the abdominal drain of robotic-assisted urology surgery.