Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
Department of Urology, NYU Langone Health, New York, NY.
Urology. 2022 Jun;164:278-285. doi: 10.1016/j.urology.2022.01.036. Epub 2022 Feb 10.
To describe the authors' experience diagnosing and managing intra-abdominal complications following robotic peritoneal flap vaginoplasty. The peritoneal flap vaginoplasty is a technique used to achieve consistent vaginal depth regardless of available natal tissue. Intra-abdominal complications following robotic peritoneal flap creation are rare but prompt diagnosis and management is critical to preventing patient harm. Given the infancy of the technique there is limited data on associated complications and their management.
Retrospective chart review identified patients undergoing robotically assisted peritoneal flap vaginoplasty by the senior authors between 2017 and 2020 who subsequently developed intra-abdominal complications requiring readmission and/or return to the operating room. Patient charts were analyzed for preoperative demographics, medical comorbidities, intraoperative details, postoperative complication presentation, diagnosis, management, and long-term outcomes.
Out of 274 patients undergoing peritoneal flap vaginoplasty during the study period, six patients were identified who developed intra-abdominal complications (2.2%). One patient developed a postoperative hematoma requiring return to the operating room for diagnostic laparoscopy and hematoma evacuation. Two patients developed intraabdominal abscesses requiring diagnostic laparoscopy and abscess drainage. One patient developed recurrent episodes of small bowel obstructions that resolved with bowel rest. Two patients developed incarcerated internal hernias requiring diagnostic laparoscopy and internal hernia reduction. In one case, the hernia occurred at the peritoneal flap closure site, and in the other case the hernia occurred at the peritoneal flap donor site.
Intra-abdominal complications following robot assisted peritoneal flap vaginoplasty are rare. In addition to hematoma and abscess, small bowel incarceration and internal hernias are potential complications of peritoneal flap vaginoplasty that require prompt attention.
描述作者在诊断和处理机器人腹膜瓣阴道成形术后腹腔内并发症方面的经验。腹膜瓣阴道成形术是一种用于实现一致阴道深度的技术，无论可用的先天组织如何。机器人腹膜瓣创建后出现的腹腔内并发症很少见，但及时诊断和处理对于防止患者伤害至关重要。鉴于该技术尚处于起步阶段，关于相关并发症及其处理的资料有限。
回顾性病历分析确定了在 2017 年至 2020 年间由高级作者进行的机器人辅助腹膜瓣阴道成形术的患者，这些患者随后出现需要再次入院和/或返回手术室的腹腔内并发症。对患者的病历进行了术前人口统计学、合并症、术中细节、术后并发症表现、诊断、治疗和长期结果的分析。
在研究期间接受腹膜瓣阴道成形术的 274 例患者中，有 6 例患者发生了腹腔内并发症（2.2%）。1 例患者发生术后血肿，需要返回手术室进行诊断性腹腔镜检查和血肿清除术。2 例患者发生腹腔脓肿，需要进行诊断性腹腔镜检查和脓肿引流术。1 例患者反复发作小肠梗阻，通过肠道休息得到缓解。2 例患者发生嵌顿性内疝，需要进行诊断性腹腔镜检查和内疝复位术。在 1 例中，疝发生在腹膜瓣关闭部位，在另 1 例中，疝发生在腹膜瓣供体部位。
机器人辅助腹膜瓣阴道成形术后发生的腹腔内并发症很少见。除血肿和脓肿外，小肠嵌顿和内疝也是腹膜瓣阴道成形术的潜在并发症，需要及时注意。
