Small bowel obstruction due to laparoscopic barbed sutures: An unknown complication?

Abstract

Background: In recent years there has been an increasing uptake in the use of barbed sutures, particularly in minimally invasive and laparoscopic procedures where they may reduce operating time and improve surgical efficiency. However, little is known about the adverse events associated with these new materials and concerns have arisen regarding their safety in certain procedures.Methods: We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database). We reveal up to 15 cases of small bowel obstruction (SBO) complicating laparoscopic pelvic surgery that have been reported to date adding two cases of SBO in our own practice following the use of barbed sutures in laparoscopic operations, both requiring surgical re-intervention in the early post-operative period.Results: Fifteen similar cases of small bowel obstruction were identified, all of which occurred in patients undergoing surgery below the transverse colon. Surgical re-intervention was required in all cases although 60% of these were performed laparoscopically.Conclusions: These cases highlight that although barbed sutures provide an attractive means to allow easier and faster laparoscopic suturing, they should be used carefully in inframesocolic surgery and the suture end cut and buried to avoid inadvertent attachment to the small bowel or its mesentery. Barbed suture entanglement should be considered as an uncommon yet potentially serious differential cause for SBO presenting in the early period after laparoscopic surgery where a barbed suture has been used.

RETRACTED ARTICLE: Use of Barbed Sutures in Bariatric Surgery. Review of the Literature

“…As far as we know, a total of 16 cases of secondary obstruction following the use of barbed sutures have been reported in the literature, possibly due to contact of barbed material and bowel loops and its ability to catch them because of their surface features [41][42][43]. Where the cut end of the barbed suture is left long, it may become firmly attached to underlying small bowel or mesentery producing kinking and a transition point of obstruction.…”

“…Torsion of the small bowel around this point of fixation may result in volvulus and where mesenteric blood flow is impeded, ischemia may also occur. All of these 16 cases required surgery, and 60 % of them were performed laparoscopically [43]. The surgeon must consider this hypothetical problem and a high index of suspicion before a postoperative obstruction.…”

“…Therefore, it is advisable to avoid contact with such material, with the recommended section having its distal end at the most proximal to the tissue exit. To prevent recurrence, the barbed suture may be additionally trimmed and buried either using absorbable sutures or surgical clips [43].…”

Generalised peritonitis from strangulated small bowel obstruction secondary to mesh erosion: a rare long-term complication of laparoscopic mesh sacrohysteropexy

“…However, there is little data on the use of barbed sutures and their safety/efficacy and there are rising concerns that they may be associated with adverse outcomes. A 2015 literature review found 13 cases of SBO following laparoscopic pelvic surgery using barbed sutures 5. Such complications have been shown specifically in LMH with a case report describing a female patient presenting on day-2 post LMH with SBO; diagnostic laparotomy revealed a volvulus where the mesentry was hooked by the end of the barbed suture 8…”

“…Rare cases of small bowel obstruction (SBO)occurring secondary to the use of a synthetic mesh in sacrohysteropexy have been reported 1–5. However, to our knowledge, we report the first case of small bowel volvulus directly attributable to the erosion of the mesh into the small bowel itself.…”