Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty: A case report and review of literature

Abstract

BACKGROUND Compared with open mesh repair, transabdominal preperitoneal (TAPP) hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery. However, it may still lead to rare but serious complications. Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom, which occurred 3 mo after TAPP repair for bilateral inguinal hernia. CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged. CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.

Closure of the Peritoneum in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) With Cyanoacrylate Glue in a Microdroplet Device: A Single Surgeon Prospective Comparison vs. Barbed Suture

“…Knowledge of the anatomy of the surgical field and the further development of new tools make this surgery simpler, faster and safer. However, the type of mesh used, its fixation and the peritoneal closure for the TAPP technique remain the issues still under discussion [1][2][3].…”

“…The following variables were taken into account: demographic variables (age, sex, BMI, ASA, type of hernia according to the EHS) [2,3], intraoperative variables (operative time, surgical conversion, intraoperative complications, flap closure time), postoperative variables hospital stay, postoperative pain according to the pain rating visual analogue scale (VAS) at 1 and 3 months, as well as seroma, haematoma, bleeding and recurrence rates. Randomization was performed using a computer-generated program.…”

A Novel Hidden Stitching Method for Preventing Complications in Laparoscopic Hernia Repair

“…11 This may explain why there are reports of intestinal adhesions and secondary intestinal obstruction caused by barbed suture in abdominal surgery. [12][13][14][15][16][17] In general, intestinal obstruction caused by barbed suture is relatively rare after upper gastrointestinal reconstruction, 18 and more common in lower abdominal and gynecological pelvic surgery. 6,17 The small intestine is more likely to contact a barbed suture in the lower abdomen or pelvis than in the upper abdomen, and due to the influence of gravity and body movement when standing, the small intestine and mesentery are more likely to be punctured by the tails of barbed sutures.…”

Bowel obstruction and perforation secondary to barbed suture after minimally invasive inguinal hernia repair: report of two cases and literature review

“…The onset time varies from 1 day to 3 months after surgery [ 18 , 21 , 22 ]. The main manifestations are abdominal pain and vomiting, and the later onset cases mainly manifest as uninterrupted abdominal pain or abdominal distension with worsening symptoms [ 17 ]. In the first case we experienced, the patient presented with unexplained vomiting and abdominal pain on the second day after surgery.…”