Postoperative mechanical small bowel obstruction induced by V-Loc barbed absorbable suture after laparoscopic distal gastrectomy

Abstract

When performing laparoscopic gastrectomy, suturing the intestinal anastomosis presents one of the greatest challenges. The V-Loc unidirectional barbed suture has been introduced to eliminate the need to tie knots during closure. This device offers a fast, secure, and effective alternative to conventional suture repair during laparoscopic surgery. However, there have been reported cases of surgical complications associated with the use of barbed suture devices. We describe here a case of small bowel obstruction resulting from improper use of barbed suture during total laparoscopic distal gastrectomy performed for gastric cancer. Following diagnosis of small bowel obstruction, the patient underwent immediate laparoscopic repair that identified the cause and relieved the small bowel obstruction. This case highlights the need for surgeons to carefully perform proper suturing technique in order to prevent complications. Surgeons should maintain a high index of suspicion for diagnosing and treating potentially severe complications when using barbed sutures.

Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer

“… By contrast, the barbed-suture materials frequently used in laparoscopic surgery could lead to the development of postoperative obstruction. Further studies are needed to assess the benefits of laparoscopic surgery for GCs, including the lower incidence of intestinal obstruction.…”

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower

“…Recently, knotless barbed sutures have been widely accepted in various operation fields. Although knotless barbed sutures have some disadvantages such as high price, impossibility of reverting the suture, and safety issues (23,24), this material has been successfully introduced to general surgery. For laparoscopic bowel suturing, reports of clinical experience have demonstrated consistent decreases in procedure time and comparable complication rates compared to conventional methods (25,26).…”

Utilización de la sutura barbada (v-loc™) en el by-pass gastroyeyunal laparoscópico: experiencia en 354 pacientes intervenidos

“…De los 354 casos sujetos a estudio (BPGYL), sólo uno tuvo que ser reintervenido mediante laparoscopia de forma urgente dentro de las 24 horas postoperatorias por cuadro de oclusión del pie de asa, no atribuible al tipo de sutura utilizado, sino a un defecto en la técnica que ocasionó torsión a ese nivel del asa alimentaria. Los casos restantes (353) no presentaron ningún tipo de complicación, durante el postoperatorio entre los 12 a 60 meses, (Me=36) relacionada con el uso de V-Loc™, lo cual sugiere la seguridad del uso de esta sutura aplicada a esta técnica, comparado con lo descrito en la literatura: dehiscencia/fístula 0.3-4%, hemorragia 1-2%, obstrucción intestinal 0.5-6%, estenosis o perforación visceral 0.8-3% y mortalidad 0.6-5% [18][19][20][21][22][23][24]. Los resultados del estudio se muestran en la Tabla 2 junto con los de otras series de referencia.…”