Strangulated bowel obstruction resulting from laparoscopic vaginal cuff closure with barbed suture

Abstract

A 50-year-old woman underwent total laparoscopic hysterectomy for CIN3. The vaginal cuff and retroperitoneum were closed with a barbed suture (V-Loc TM 180). She had an uneventful postoperative course and was discharged on postoperative day 5. On postoperative day 12, she returned to our department with sudden onset of abdominal pain and vomiting. Physical examination revealed rebound tenderness, and contrast-enhanced computed tomography showed strangulated bowel obstruction. An emergency laparotomy was performed; the end of the barbed suture was ingrowing into the mesentery of the small bowel. The small bowel around the suture was adhered to the pelvic peritoneum. The suture was cut, the adhesion was separated manually, and the suture material was explanted from the small bowel. No bowel resection was required. She had an uneventful subsequent postoperative course. Although the use of a barbed suture is convenient and timesaving, it may be implicated as a cause of bowel obstruction. This complication may be avoided if there is no exposure of the free end of the barbed suture in the peritoneal cavity.