Small Bowel Obstruction Secondary to Barbed Suture after Minimally Invasive Inguinal Hernia Repair

Zipple, Monica; Bankhead‐Kendall, Brittany; Roy, Mikhail D; Yaldo, Bashar

doi:10.1177/000313482008600108

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Maejima

Fukahori

2022

The American Surgeon™

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Purpose Barbed suture provides a rapid and effective method for closure in minimally invasive surgery. However, postoperative complications involving barbed suture have been reported in recent years. The aim of this study is to introduce a novel hidden stitching technique for peritoneal closure in laparoscopic hernia repair. Method This study retrospectively analyzed the data of patients with laparoscopic transabdominal preperitoneal patch (TAPP). In the hidden stitch (HS) group, the barbed suture was hidden on the dorsal side of the peritoneum and two stitches were returned in the opposite direction after the suture reached the end point. In the non-hidden stitch (NHS) group, the barbed sutured was exposed in the peritoneal cavity with a tail stump of approximately 10 mm preserved to prevent the peritoneal sutures from loosening. Results Twenty-seven patients in the HS group were compared with 53 in the NHS group. There were no differences in age, body mass index, surgical bleeding, or length of hospital stay between the two groups. The peritoneal defect closure time was slightly longer (3 min) in the HS group, but the overall operation time was not significantly extended. There were 8 cases of postoperative complications (P = .035) including 4 cases of bowel obstruction due to the tail of the barbed thread penetrating the small intestine mesenteric and two cases of seroma. There were no postoperative complications in the HS group. Conclusions The hidden stitch method is a safe and feasible peritoneal closure technique that may reduce postoperative complications caused by barbed suture in laparoscopic hernia repair.

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Section: Discussionmentioning

confidence: 99%

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

Wang

Maejima

Fukahori

2022

The American Surgeon™

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“…But new products cannot always be perfect. Recently, reports of related complications have been published [4,[15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…We searched on PubMed with keywords including barbed suture, complication, and TAPP, and found a total of eight case reports from 2012 to 2021. 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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Laparoscopic transabdominal preperitoneal patch (TAPP) is now commonly used in the repair of inguinal hernia. Barbed suture can be a fast and effective method of peritoneal closure. We report two rare cases of small bowel obstruction and perforation caused by barbed suture after TAPP. Cases Patient 1 is a 45-year-old man who underwent laparoscopic repair of a right inguinal hernia. Barbed suture was used to close the peritoneal defect. At 47 days after the operation, he was diagnosed with a small bowel obstruction caused by an elongated tail of the barbed suture. Emergency laparoscopic exploration was performed for removal of the embedded suture and detorsion of the volvulus. The second patient is a 50-year-old man who was admitted with a small bowel perforation one week after TAPP herniorrhaphy. Emergency exploration revealed that the tail of the barbed suture had pierced the small intestine, causing a tiny perforation. After cutting and releasing the redundant tail of the barbed suture, the serosal and muscular defect was closed with 2 absorbable single-knot sutures. Both patients have recovered well. Finally, we searched the PubMed database and reviewed the literature on the effectiveness and safety of barbed suture for TAPP. Conclusions Surgeons should understand the characteristics of barbed suture and master the technique of peritoneum closure during TAPP in order to reduce the risk of bowel obstruction and perforation.

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“…The manufacturer of V-Loc sutures recommends that the suture stump should include additional peritoneal tissue surrounding the closure[ 25 ]. A literature review found that the end of the suture line seems to be essential[ 26 - 29 ]. Similar small bowel obstructions or volvulus complications following use of V-Loc sutures have been reported in the context of gastrointestinal and gynecological surgery[ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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

Man¹,

Li²,

Zhang³

et al. 2021

WJCC

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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.

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Small Bowel Obstruction Secondary to Barbed Suture after Minimally Invasive Inguinal Hernia Repair

Cited by 7 publications

References 4 publications

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

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

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

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

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