Complications of Robotic Gastrointestinal Surgery : A Case Report of An Adhesive Small Bowel Obstruction
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Abstract
Background:
Robotic surgery is increasingly used in gastrointestinal surgical procedures for its precision, threedimensional visualization and smaller incisions. However, postoperative complications can still occur including adhesive small bowel obstruction (ASBO). ASBO results from fibrous bands that kink or entrap bowel loops and its diagnosis is primarily clinical and supported by CT imaging. Although overall safety profiles approximate laparoscopy studies have documented postoperative complications after robotic surgery.
Case summary:
A 74-year-old man underwent robotic umbilical hernia repair with mesh. Four months later, he presented with cessation of stool, abdominal distension and bilious vomiting, with a distended, tympanic abdomen on examination and air–fluid levels on plain radiography. Contrast-enhanced CT demonstrated small-bowel distension with a transition point in the right iliac fossa. Intraoperatively the small bowel was dilated without any signs of ischemia and the obstruction was caused by a fibrous
band between the small intestine and mesentery (small bowel–mesenteric adhesion). Adhesiolysis with division of the adhesive band was performed. Bowel transit resumed within 24 hours and the patient was discharged on postoperative day two and had an uneventful 6-week follow-up with return
to normal activity.
Conclusion:
This case highlights ASBO as a potential delayed complication after minimally invasive robotic abdominal surgery even following seemingly straightforward procedures such as umbilical hernia repair with mesh. Early recognition with CT to localize the transition point and timely operative adhesiolysis can yield rapid recovery and excellent short-term outcomes. Vigilance for ASBO should
be maintained in post-robotic surgery patients presenting with obstructive symptoms and clinicians should counsel patients regarding this risk despite the overall favorable safety profile of robotic techniques.