Small Bowel Complications After Sacrocolpopexy: A Case Series.

Abstract

Importance: Ileus and small bowel obstructions are known but rare complications associated with minimally invasive sacrocolpopexy that can result in variable management.

Objectives: The objectives of this study were to describe the clinical presentation, management and outcomes of ileus or small bowel obstructions after minimally invasive sacrocolpopexy.

Study design: This was a multicenter retrospective case series of postoperative ileus or small bowel obstruction after minimally invasive sacrocolpopexy. Demographics, clinical, surgical, and complication characteristics were manually abstracted. Descriptive statistics were performed via SPSS along with associative and comparative analyses.

Results: Ileus or small bowel obstruction was diagnosed in 2.5%, 95% CI = 1.8,3.3%, of all minimally invasive sacrocolpopexy cases across institutions. Presentation for small bowel complication ranged from 1 to 2,432 days after surgery with 70% presenting within 14 days of the index surgery. Remoteness from the surgery was associated with whether the index team was involved in the management of the bowel complication. Patients who were conservatively managed were admitted for a significantly shorter amount of time with a mean length of stay of 4.52 (±3) days compared to 10.3 (±6, P  < 0.001) days for those who were surgically managed.

Conclusions: Small bowel complication is a known rare risk following minimally invasive sacrocolpopexy. Conservative management resolves the majority of cases and should be considered to reduce the risk of surgical morbidity or disruption of the mesh. Given that multiple clinical teams may encounter and manage these complications, our study highlights the importance of keeping a high index of suspicion and thoughtful communication about these events.