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Delayed small bowel obstruction after robotic-assisted sacrocolpopexy
Sevan A Vahanian1, Peter S Finamore, George Lazarou
1From the Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY.
Female Pelvic Medicine & Reconstructive Surgery
|September 5, 2014
Summary
Two patients experienced bowel obstruction weeks after robotic sacrocolpopexy due to barbed suture adherence. Prompt surgical intervention resolved the issue, highlighting a rare complication of this common procedure.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Robotic-assisted sacrocolpopexy is a common surgical procedure for treating uterovaginal prolapse.
- The procedure involves mesh placement secured with sutures, often including barbed sutures for peritoneal closure.
- While generally safe, potential complications require ongoing investigation.
Observation:
- Two patients presented with symptoms of nausea, vomiting, and abdominal pain 3-4 weeks post-surgery.
- Both patients had undergone robotic-assisted supracervical hysterectomy and sacrocolpopexy.
- Surgical exploration revealed small bowel adhered to a barbed suture at the sacral promontory.
Findings:
- Partial small bowel obstruction was diagnosed in both patients.
- The obstruction was directly caused by adherence of the small bowel to a barbed suture used for mesh fixation.
- Surgical release of the adhered bowel loop led to uncomplicated recovery.
Implications:
- Barbed sutures, while efficient, may pose a risk of adhesion and subsequent bowel obstruction.
- Surgeons should be aware of this potential complication following robotic-assisted sacrocolpopexy.
- Further research into suture material and placement techniques may be warranted to minimize such risks.
