Small bowel obstruction SBO after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report

Abstract

A 50-year-old man underwent laparoscopic hernia repair for a groin hernia, presenting acute abdominal pain and bowel obstruction syndrome 1 day post surgery. Diagnostic laparoscopy was performed at postoperative the day after the hernioplasty and a volvulus was found. The residual end of the barbed V-LOC adopted in the peritoneal closure was incidentally hooked to the mesentery and caused a small bowel obstruction as a volvulus. The redundant V-LOC strand was released and cut superficial to the peritoneum. A detorsion of volvulus was preformed. Neither bowel ischemia nor significant bowel injury was noted. The following day he was discharged without complication. The residual ‘free’ barbel suture in the peritoneal cavity invited adhesion formations and subsequently the Bowel obstruction.

Case Report: Small Bowel Obstruction Owing to Self-Anchoring Barbed Suture Device After TAPP Repair

“…Statistical data indicate that the incidence of SBO after TAPP repair ranges from 0.2% to 0.5% ( 5 ) and is usually attributed to inadequate peritoneal closure, trocar site herniation, or adhesion ( 6 ). We identified other case reports similar to ours, in which a self-anchoring barbed suture remained after TAPP repair and caused SBO ( 7 , 8 ). Although such cases are rare, they provide many clinical learning points.…”

Adhesional small bowel obstruction related to stapling device from previous laparoscopic inguinal hernia repair

“…SBO post-TAPP can be attributed to inadequate closure, port-site herniation and adhesional band formation postoperatively 7. As a result, we have only identified a few case reports case like ours where a retained staple during TAPP repairs caused mechanical small obstruction 7–9. Although uncommon, this case report highlights several important clinical learning points.…”

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

“…We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database) for evaluation of similar cases and identified only four cases of inguinal hernia repair complicated by obstruction due to barbed suture (see Table 1). [1][2][3][4] The type of barbed suture used, suture placement, and surgical interventions performed were also reviewed. In our case, the loose tail of the V-loc Ò suture adhered to the small bowel, causing a functional obstruction.…”

“…Reports suggest minimally invasive approaches to release of obstruction related to barbed suture can be safe with minimal complications. 1,3,4 Appropriate patient selection is critical, considering timing since initial surgery, the patient's past surgical history, and comorbid conditions in surgical planning. A high index of suspicion should be maintained for prompt management of these patients to prevent further complications (such as ischemia or perforation mandating bowel resection).…”