Transabdominal Preperitoneal Hernia Repair Research Articles

V-009 Robot-Assisted Repair of a Traumatic Hernia After a Pelvic Fracture: Case Report and Literature Review

Abstract Aim Traumatic abdominal wall hernias (TAWH) are an uncommon clinical entity, accounting for less than 0.2% of all blunt trauma injuries. Management and operative technique are still a matter of debate and the role of the robotic surgical platform in traumatic hernias has not been reported on. We present a robot-assisted repair of a TAWH through a fracture of the left iliac wing. We aim to describe our operative approach and perform a review of the literature. Material and methods A 46-year-old male with a history of a high energetic trauma presented with a symptomatic swelling in the left lumbar region. Further imaging showed an important defect of the abdominal wall caused by a disruption of the iliac and gluteus muscles and non-union of a left iliac wing fracture. This caused a herniation of the descending colon. A robot-assisted transabdominal preperitoneal hernia repair (TAPP) with synthetic mesh was performed in elective setting. Results The postoperative course was uneventful. Discharge was possible at postoperative day one. There was no surgical site infection, seroma, or recurrence after a follow-up period of 6 months. Conclusions To our knowledge, we describe the first robot-assisted repair of a TAWH through a pelvic fracture. Our technique was safe and feasible. In difficult to reach areas of the abdomen, a robot-assisted repair might be a valid approach. Larger studies are needed to confirm our initial experience in traumatic abominal wall hernia surgery.

Quality of Life after Desarda Technique for Inguinal Hernia Repair-A Comparative Retrospective Multicenter Study of 120 Patients.

Inguinal hernia repair, according to Desarda, is a pure tissue surgical technique using external oblique fascia to reinforce the posterior wall of the inguinal canal. This has provided an impetus for the rethinking of guideline adherence toward minimally invasive and mesh-based surgery of inguinal hernia. In this study, a retrospective analysis of this technique was conducted in two German hospitals. Between 6/2013 and 12/2020, 120 operations were performed. Analysis included patient characteristics, duration of operation, length of hospital stay, and perioperative complications. Data were used to achieve a matched-pair analysis comparing Desarda to laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Propensity scores were calculated based on five preoperative variables, including sex, age, American Society of Anesthesiology classification, localization, and width of the inguinal hernia in order to achieve comparability. Additionally, we assessed pain level and quality of life (QoL) 12 months postoperatively. The focus of our study was a comparison of QoL to a reference population and TAPP cohort. The study population consisted of 106 male and 14 female patients, and the median age was 37.5 years. The median operation time was 50 min, and the median length of hospital stay was 2 days. At a follow-up of 17 months, the median recurrence rate was 0.8%, and two cases of chronic postoperative pain were recorded. Postoperative QoL does not significantly differ between Desarda and TAPP. In contrast, Desarda patients had a significantly higher QoL compared with the reference population. In summary, Desarda's procedure is a good option as a pure tissue method for inguinal hernia repair.

One-year experience of robotic transabdominal preperitoneal approach in a single institute: 2 different surgeons with different levels of experience.

The robotic platform, an extension of minimally invasive procedures, is distributed nationwide and readily available. However, its application in inguinal hernia repair seems rare in Korea. This report aims to share our initial experience with robotic inguinal hernia repair. The patients who underwent robotic inguinal hernia repair by 2 different surgeons with different experiences at a single center were retrospectively analyzed. The surgical procedures were performed on all patients using the Da Vinci Xi robotic platform (Intuitive Surgical Inc). Patient demographics, operation variables, and postoperative outcomes were analyzed. A total of 35 patients underwent robotic inguinal hernia repairs consecutively. The mean age was 55.03 ± 18.20 years. The majority of patients were male. The overall mean operation time was 103.98 ± 47.92 minutes for unilateral hernia surgery and 139.28 ± 46.07 minutes for bilateral surgery. None of the patients experienced intraoperative complications. However, postoperative complications were noticed in 8 patients: 3 with seroma formation, 1 with hematoma, 1 with superficial surgical site infection, and 3 with persistent pain at the operation site. This report demonstrates an early experience of hernia surgery using the robotic platform. The robotic approach for transabdominal preperitoneal hernia repair was completed without any significant intraoperative or postoperative complications. It may be a viable option as a minimally invasive technique. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case.

Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.

V-027 2-IN1: LAPAROSCOPIC TAPP REPAIR OF CONCURRENT SPIGELIAN AND INGUINAL HERNIAS

Abstract Aim Spigelian hernias are rare hernias of the abdominal wall and difficult to diagnose clinically. Our aim is to report a diagnostic and surgical challenge of the combination of inguinal and Spigelian hernias. Material &amp; Methods 74 year old female presented with pain in right inguinal region and lump in right iliac fossa. The ultrasound scan revealed right sided Spigelian hernia up to 4 cm, right inguinal hernia up to 1 cm and incidentally detected contralateral Spigelian hernia up to 3 cm on the left side. Results Laparoscopic transabdominal preperitoneal (TAPP) hernia repair was performed of both right Spigelian and ipsilateral inguinal hernias. The hernia sacs were dissected and 25×15 cm polypropylene mesh was placed, covering both hernia sites. The mesh was fixed using absorbable tacks. The peritoneum was closed using barbed suture. The repair of contralateral Spigelian hernia was planned as a second stage procedure due to the present comorbidities. Operation time was 140 min. The patient was discharged on the next postoperative day. Ultrasound scan performed after 3 weeks did not show any signs of seroma, hematoma or recurrence. Conclusions An accurate preoperative diagnosis of Spigelian and inguinal hernias led to the safe and successful laparoscopic repair with preperitoneal mesh placement.

SAFETY OF SIMULTANEOUS LAPAROSCOPIC APPENDECTOMY IN COMBINATION WITH LAPAROSCOPIC HERNIA REPAIR (TAPP). A SERIES OF CLINICAL CASES

Aim: To evaluate the technical feasibility and safety of a simultaneous surgery: laparoscopic appendectomy in combination with transabdominal preperitoneal hernia repair.Methods: The study was a retrospective analytical one. The medical histories were studied and postoperative monitoring of eleven patients hospitalized with acute appendicitis who underwent simultaneous surgery: laparoscopic appendectomy with simultaneous laparoscopic plastic surgery of clinically significant inguinal hernia was carried out. During the statistical analysis, the following parameters were evaluated: the timing of postoperative recovery, the frequency of early postoperative complications and the frequency of recurrence of inguinal hernia a year after surgery.Results: The surgery was successfully performed in all 11 patients. There were no cases of infectious complications of the surgical intervention area. Acute urinary retention was registered in one patient in the early postoperative period. In one case, an early adhesive intestinal obstruction was diagnosed, which was resolved with conservative treatment. There were no cases of recurrent inguinal hernia during the year.Conclusion: laparoscopic appendectomy in combination with transabdominal preperitoneal hernia repair can be used in the treatment of acute appendicitis in combination with inguinal hernia in the absence of signs of gangrenous appendicitis with purulent peritonitis. The low statistical power of the study does not allow us to draw conclusions about the safety of this approach for patients of the older age group with a high comorbidity index.

A FEATURE OF LAPAROSCOPIC TREATMENT OF IRREDUCIBLE AND LARGE INGUINAL HERNIAS

Summary. Introduction. The inguinal hernia is one of the most common surgical problems around the world. Patients with large inguinal and inguinal hernias are a certain group. At present, there are no final convincing evidence of the advantage of laparoscopic hernia repair of complex forms of inguinal hernias, indications and contraindications to various methods of this operation, the technology of performing surgical interventions for various types of complex inguinal hernias has not been completed.&#x0D; Aim. Perform perioperative complications in surgical treatment of unrecognizable and large inguinal hernias with laparoscopic modified TAPP method, classic Laparoscopic TEP laparoscopic technique and inguinal canal plastic according to Lichtenstein.&#x0D; Materials and methods. Surgical treatment of 42 patients with unrecognizable and large inguinal hernias was performed. All of them were performed incapacitated plastic with the use of a prone grid. In 12 patients, the Lichtenstein (Lichtenstein group) was performed, 18 patients with a modified technique (TAPP group) and 12 — TEP (TEP group). Modification was a high resection of the hernia sac in patients with inguinal-callous hernia, and the techniques of digestion of the peritoneum with a fixed gut in cases where the intestine is tightly fictoned in a large length to the peritoneum in the area of the hernia sac.&#x0D; Results of the research. Application in the performance of transabdominal preperitoneal hernia repair of the technique of high resection of the hernia sac in patients with inguinal-potassium hernia, and methods Surgery, reduce the frequency of hematoma and inflammatory processes in the TAPP surgery area is likely (p &lt; 0.05), and reduce the number of conversions in the TAPP group.&#x0D; Conclusions. Diagnostic laparoscopy is a necessary highly informative stage of diagnosis and determination of surgical tactics for complex types of inguinal hernias. Laparoscopic hernia repair of complex forms of inguinal hernias is a method of choice, which provides low trauma, asepticity, good conditions for wound healing. Modified technique of transabdominal preperitoneal hernia repair of complex inguinal hernias, which reduced the trauma of the operation and thus reduce intra and postoperative complications that are manifested by the formation of hematoma and inflammatory processes in the surgery.

Influence of the hernia sac treatment method on the occurrence of seroma after laparoscopic transabdominal preperitoneal hernia repair

PurposeTo determine whether transection of the hernia sac during laparoscopic transabdominal preperitoneal hernia repair (TAPP) affects the occurrence of seroma, and to explore the risk factors for seroma. MethodsIn total, 330 consecutive male patients with indirect inguinal hernia who underwent TAPP repair at the Qingdao University Affiliated Hospital from January 2020 to June 2021 were retrospectively enrolled in this study. According to the intraoperative hernia sac treatment, patients were divided into a completely reduced sac group and a transected sac group. ResultsAmong the 330 inguinal hernia male patients, 240 received hernia sac reduction and 90 received hernia sac transection. Fifty-four patients developed seroma, with an incidence of 16.4%. In patients with a hernia defect measuring ≥3 cm and extension into the scrotum, the difference in the incidence of seroma between the two treatment groups approached significance (P = 0.052). The risk factors for seroma, high body mass index, hernia sac ≥3 cm, extension of the hernia into the scrotum and operation time were significantly associated with postoperative seroma. ConclusionThis study showed that the incidence of seroma after TAPP was as high as 16.4%. For patients with a hernia sac that is too large and descended extends into the scrotum, transection may be better than complete dissection of the hernia sac and preventive measures should be taken for patients with high body mass index, hernia sac measuring ≥3 cm, and a high risk of the hernia extending into the scrotum.

Post-Operative Pain in Transabdominal Preperitoneal (TAPP) Hernia Repair: Mesh Fixation with Tacks Versus Non-Fixation

Objective: To find the post-operative pain in transabdominal preperitoneal (TAPP) hernia repair: Mesh fixation with tacks versus non fixation. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit B, Mardan Medical Complex, Mardan from 1st October 2019 to 30th September 2021. Methodology: One hundred participants who were admitted for inguinal hernia repair through laparoscopic surgical procedure were enrolled as study participants and divided into two groups. General anesthesia was administered to all patients and a carbon dioxide pressure of 14mmHg was used for keeping pneumo-peritoneum during the surgical procedure. An incision in peritoneum was made post identification of herniasac. Pain index was measured by Visual Analogue Scale at day 1, day 3, day 7 and day 14 followed by one and six months post-surgery. Results: The mean age of group A and group B patients in the present study were 51.2±9.5 and 52.1±9.7 years respectively with majority being males in both groups. Majority of patients in both group had unilateral herni. Group B had shorter surgery duration with lessen hospital stay however chances of recurrence as 12% and wound infection as 6% was higher in it respectively. The post operative pain was 65±9.3 and 66±9.1 in group A and B. Conclusion: Mesh fixation is a longer duration process requiring longer hospital stay, however it provides less chances of complications as wound infection and recurrence. There was no difference in post operative pain in both groups. Keywords: Hernia Repair, Fixation, Mesh, Surgical Method

Outcomes after laparoscopic transabdominal preperitoneal (TAPP) hernia repair in the emergency: A matched case-control study

Outcomes after laparoscopic transabdominal preperitoneal (TAPP) hernia repair in the emergency: A matched case-control study

Feasibility of laparoscopic indirect inguinal hernia repair with lateral umbilical fold covering internal inguinal ring combined with patch repair.

For an indirect inguinal hernia (IIH), it is a challenge to repair the internal inguinal ring (IIR) with self-tissue reconstruction in laparoscopic repair. To evaluate the efficacy and safety of covering the IIR with the lateral umbilical fold (LUF) combined with patch repair in laparoscopic indirect inguinal hernia repair. Patients with IIH treated by trans-abdominal preperitoneal (TAPP) hernia repair at the Department of General Surgery, Shanghai Public Health Clinical Centre between September 2019 and March 2021 were retrospectively analyzed. In group I (n = 57) the LUF was overturned and sutured to cover the IIR under a laparoscope and subsequently repaired with a patch. In group II (n = 62), the IIR was not covered by the LUF but only repaired with a self-gripping mesh. We noted a longer suture time in group I than in group II. Although the LUF was covered after suturing, no significant difference in postoperative pain was observed between the two groups. However, significant differences in surgery time and hospitalization cost (p < 0.05) were found. One case of recurrence was observed in group II. The LUF can be used in IIH to cover the IIR and is a feasible approach. The LUF covering the IIR has no significant difference in pain.

Robotic transabdominal preperitoneal morgagni hernia repair technique

Robotic transabdominal preperitoneal Morgagni hernia repair: A step-wise approach. Morgagni hernia (MH) is an atypical and rare type of diaphragmatic hernia that presents surgical challenges given its location and proximity to vital structures. Classically, these hernias have been repaired either open or laparoscopically with the use of an intraperitoneal onlay mesh without defect closure. Borrowing from the groups’ excellent experience in robotic transabdominal preperitoneal hernia repair (rTAPP) ventral and atypically located hernias, this approach has shown promise in repairing MHs in albeit a small cohort of patients. The rTAPP technique in our opinion overcomes many of the challenges and pitfalls associated with atypical hernias, including those of the diaphragm, providing excellent visualization and facilitating wide preperitoneal dissection with a complete reduction of the hernia sac located in the anterior mediastinum. The wide preperitoneal exposure allows for directed diaphragmatic closure, minimizing the risk of injury to mediastinal structures, placement of a large uncoated mesh sandwiched in between layers of the abdominal wall, and safely targeted fixation at cardinal points. Preperitoneal mesh allows for the use of a more cost-effective uncoated mesh that is not exposed to the viscera. It also allows for minimal and targeted fixation without the use of tacks, leading to decreased postoperative pain and complications. In this article, we are detailing the rTAPP approach in managing MHs.

Assessment of feasibility and safety of cyanoacrylate glue versus absorbable tacks for inguinal hernia mesh fixation. A prospective comparative study.

Mesh fixation is one of the most important steps in laparoscopic inguinal hernia repair. Tacks are often used and provide reliable fixation but they increase the risk of bleeding and chronic pain. To decrease chronic pain, absorbable tacks have been more recently developed. Another method is fixation via glue, which is the most minimally invasive approach, but it may theoretically lead to higher rates of fixation failure. To analyse the intraoperative mesh fixation success rate and postoperative outcomes between cyanoacrylate and absorbable tacks in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Adult patients who underwent TAPP hernia repair were included prospectively. Patients were split into two groups: the study group (LB) in which the mesh was fixed with cyanoacrylate glue and the control group (AT) in which absorbable tacks were used. Main outcomes were fixation success rate, early postoperative pain, chronic pain, patient reported outcomes and recurrence rate. The mesh fixation success rate when using LB was 96.70% (n = 88), while in the AT group, the mesh fixation success rate was 100% (n = 120). Patients in the AT group had significantly higher pain scores than patient in the LB group (p < 0.001, 95% CI). There was no significant difference in chronic pain, patient reported outcomes or recurrences between the two groups. Cyanoacrylate glue is a safe option for mesh fixation in transabdominal preperitoneal laparoscopic inguinal hernia repair with improved early postoperative pain and similar chronic pain, patient reported outcomes and recurrence when compared to absorbable tack fixation.

Safety and Feasibility of Laparoscopic Transabdominal Preperitoneal Hernia Repair for Octo- and Nonagenarians.

Background: The feasibility of laparoscopic hernia repair in octo- and nonagenarians has not been investigated in detail. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic hernia repair in octo- and nonagenarians. Methods: This study included 607 patients who underwent transabdominal preperitoneal laparoscopic hernia repair at our hospital between April 2014 and October 2020. Patients were divided into an over 80 group (112 patients aged 80 years and older) and a control group (495 patients younger than 80 years). The clinical outcomes were compared between the groups. In addition, among patients aged 80 years and older, those who underwent elective laparoscopic hernia repair (laparoscopic group: 111 patients) were compared with patients who underwent elective open hernia repair during the same study period (open group: 79 patients). Results: The number of patients who underwent bilateral hernia repair was significantly larger in the over 80 group (26.7% versus 11.7%, P < .001). The incidence of postoperative complications was not significantly different between the over 80 group and the control group. Compared with open group, the number of patients who underwent bilateral hernia repair was significantly larger in the laparoscopic group (27.0% versus 2.5%, P < .001). The incidence of postoperative complications (2.7% versus 10.1%) and the incidence of readmission (0.9% versus 6.3%) were significantly greater in the open group. Conclusions: Laparoscopic hernia repair in octo- and nonagenarian patients yields safe and noninferior outcomes. Laparoscopic hernia repair in octo- and nonagenarian patients is considered more suitable for detecting and repairing contralateral hernias simultaneously.

Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair.

Laparoscopic transabdominal preperitoneal hernia repair (TAPP) is one of the most widely used methods in inguinal hernia surgery. After the mesh is placed, the peritoneum must be resutured to avoid contact with the tissues and organs in the abdominal cavity. If the peritoneal suture time is too long, the operation and anesthesia time will be prolonged, increasing the burden on the patient. Moreover, improper suture methods cause serious consequences, such as intestinal obstruction and mesh infection. The straight-needle suture method transforms the three-dimensional spatial configuration of the needle holder and the arc needle tip into a two-dimensional planar structure, which greatly reduces the difficulty of suturing. The three-tailed knot can be anchored at the beginning of the suture by its friction and button effect, which has an exact fixation effect. Thus, the suture does not easily slip, and the time to complete the suturing is shortened. Compared with the traditional suture method, the operator can suture the peritoneum more quickly, beginners can pass through the difficult learning curve faster, and skilled operators can also shorten the total operation time of TAPP to a certain extent. Thus, this suture method is extremely amenable to clinical application.

Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair

Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair

Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial.

Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair. This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days. 62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2min, SD = 17.7; LDAI group: 127.1min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2min, SD = 15.9; LDAI group: 103.8min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups. LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.

Intestinal Obstruction Due to Titanium Tack after TAPP Inguinal Hernia Repair

Background: Small bowel obstruction (SBO) after transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair is a rare complication. It is generally associated to a failure of the peritoneal gap closure with intestinal loops passing through the gap. Case Presentation: We report a case of SBO secondary to titanium tack after 2 weeks of laparoscopic TAPP repair managed by laparoscopic approach, and we update some considerations about this unfortunate complication. Conclusion: SBO due to mechanical fixation devices utilized in laparoscopic TAPP repairs is infrequent. In case of closing of peritoneal gap with tacks, those with low exposition profile and absorbable should be preferred.

A cost analysis of two- versus three-instrument robotic-assisted inguinal hernia repair with mesh: time is money.

Equipment expenses and operating times can lead to higher costs with robotic surgery. We compared the cost-effectiveness of 2- vs. 3-instrument (2i vs. 3i) approach to robotic transabdominal preperitoneal inguinal hernia repair. We conducted a retrospective study of 172 patients, with 86 patients in each group. Procedure cost, operative time, morbidity, length of stay, readmission rate, and hernia recurrence at 90days were compared. Statistical significance was assigned to p < 0.05. No significant differences in preoperative variables nor in postoperative outcomes were identified. Mean operative time was 6min longer in the 2i group and this approach cost $300 less. The 2i approach was cost-effective for operating room (OR) costs of less than $50 per minute. Surgeon efficiency and OR dollar-per-minute value influence the potential for cost savings with fewer instruments in robotic herniorrhaphy. There is no difference in outcomes when fewer instruments are used.

Acute colonic pseudo-obstruction and rapid septic progression after transabdominal preperitoneal hernia repair: a case report

BackgroundAcute colonic pseudo-obstruction (ACPO) is a rare condition observed in patients with some underlying medical or surgical conditions. To the best of our knowledge, this is the first case report of a patient with ACPO development and rapid septic progression after laparoscopic inguinal hernia repair.Case presentationA 78-year-old man who underwent transabdominal preperitoneal hernia repair (TAPP) for right inguinal hernia presented with difficulty in defecation and abdominal distension. He visited our emergency department on the third postoperative day. Enhanced computed tomography (CT) detected marked enlargement from the cecum to the rectum. There was no evidence of mechanical obstruction, ischemia, or perforation. He was diagnosed with postoperative constipation and received conservative management. He gradually started to improve; however, he suddenly experienced cardiopulmonary arrest 30 h after admission and could not be resuscitated. CT imaging of the abdomen during autopsy did not show any significant change, such as perforation, from the time of admission. Based on the clinical course and examination results, postoperative ACPO was considered the fundamental cause of fulminant obstructive colitis leading to sepsis.ConclusionsACPO following minimally invasive surgery is exceedingly rare. However, it is important to consider this disease as one of the differential diagnoses to avoid missing the chance for advanced therapy.