Laparoscopic Management of Small Bowel Obstruction after Robotic Bilateral Inguinal Hernia Repair

Alan Saber, MD, FACS

Product Details
Product ID: ACS-6136
Year Produced: 2020
Length: 5 min.


Introduction: Transabdominal preperitoneal (TAPP) approach for bilateral inguinal hernias is becoming a popular procedure both laparoscopically and robotically. While TAPP may decrease overall pain and allow for quicker recovery as compared to an open approach, it does not come without its complications. We here in presenting a patient who developed closed loop small bowel obstruction after bilateral robotic inguinal hernia repair that was repaired laparoscopically with a positive outcome. Presentation: A 53 year-old male presented to ED with diffuse abdominal pain and bilious emesis 3 days after robotic bilateral inguinal hernia repair. The patient was hemodynamically stable. CT scan showed small bowel obstruction probably adhesive. His symptoms persisted despite conservative management. Patient was taken for a diagnostic laparoscopy. Procedure: Diagnostic laparoscopy revealed a loop of small bowel herniated through a reopened peritoneal defect of the recent robotic inguinal hernia repair. The loop was adhered to the preperitoneal mesh. The herniated loop was gently reduced and found to be viable. The peritoneal defect was then closed using a 2/0- absorbable suture in a running fashion. Postoperative Course: The patient did well. Tolerated diet and was discharged on POD 2. Conclusion: In hemodynamic stable patient with early postoperative small bowel obstruction without peritoneal signs a trial of conservative management is reasonable. However, herniated bowel through a peritoneal defect of a recent TAPP repair should be considered if obstruction does not relieve with conservative management. In such situation, diagnostic laparoscopy should be considered to rule out closed loop obstruction.