Management of postoperative ileus after robot-assisted radical prostatectomy

Introduction: The use of robot-assisted radical prostatectomy (RARP) for localized prostate cancer has increased in recent years. Postoperative ileus (POI) is the most common perioperative complication leading to delayed discharge after RARP. The incidence and management of prolonged POI from at our institution were reviewed. Materials and Methods: A total of 958 RARPs were reviewed. Prolonged POI was defined as intolerance of an oral diet that continued until the postoperative day 6 and beyond. All data including the patients' characteristics, comorbidities, perioperative outcome, and management of prolonged POI were assessed. Results: Seven patients experienced prolonged POI. Four of these seven patients (57%) recovered under conservative treatment. Three patients (43%) needed surgical reexploration were identified by abdominal computed tomography (CT) scan, including one adhesive intestinal obstruction and two incarcerated inguinal hernias. The laparoscopic reexplorations were successfully performed for the three patients. Conclusion: For patients with prolonged POI failing initial conservative treatment, a prompt CT survey is crucial for early detection of patients requiring surgical intervention, helps to avoid intra-abdominal adhesion during the exploratory laparotomy and reduces associated surgical complications.