Management of ileus or small bowel obstruction after minimally invasive sacrocolpopexy; a multicenter case series

Bowel complications after sacrocolpopexy are rare but potentially morbid conditions. The objectives of this study are to describe the clinical presentation, management and outcomes of ileus or small bowel obstruction (SBO) after minimally invasive sacrocolpopexy (MI-SCP). This is a multicenter retrospective case series of patients with postoperative ileus or SBO after a MIS-SCP at two high-volume institutions between January 1, 2009 and December 31, 2021. Cases were included if the index surgery and readmission for ileus/SBO were captured in the electronic medical records (EMR). Demographics, clinical and surgical characteristics were abstracted through manual chart review. Descriptive statistics were performed via SPSS. Forty-three cases of ileus/SBO after MIS-SCP were identified. The mean (±SD) age was 59.6 (±11.9) years and median (IQR) BMI was 24 (21-27) kg/m2 at the time of SCP. The cohort was predominantly white and non-latina (86% and 88%). Half of the cohort had prior abdominal surgeries and none had abdominal surgeries during the interval between MI-SCP and the initial presentation for ileus/SBO. Additionally, 21% had preoperative functional gastrointestinal diagnoses. Most cases included concomitant hysterectomy (81%). Similar proportions of MI-SCPs were performed robotically and laparoscopically. Reperitonealization was not routinely performed at one of the institutions. The median estimated blood loss was 100 (50-150) mL and mean operative time was 201 (±60) minutes. Intraoperative adhesions were noted in 21% of the index cases (Figure). Presentation for ileus/SBO ranged from 1-2432 days post-surgery with 80% presenting within 14 days of the index surgery; the most common presenting symptoms were nausea and vomiting (81%). SBO was the most common diagnosis (61%) followed by ileus (26%) and port site hernia (14%). All port site hernias were managed surgically upon diagnosis. All diagnoses were confirmed with computed tomography with the exception of one port site hernia diagnosed with bedside ultrasound. Most cases were managed conservatively (72%) and only 2 out of the 12 surgically managed cases included mesh excision (Figure 1). One instance of mesh excision was performed by general surgery without involvement of urogynecology, and the other was performed by urogynecology for gross spillage of feculent material during port site hernia reduction. Those who were conservatively managed were admitted for a significantly shorter amount of time with a mean length of stay of 4.5 (±3) days compared to 10.3 (±6) days for those who were surgically managed. Demographics and surgical characteristics were not statistically different between conservatively or surgically managed patients. This case series describes the clinical presentation and management of ileus/SBO after MI-SCP. The majority of cases presented early in the postoperative course and were successfully managed conservatively without need for surgery or mesh disruption.