Benjamin Clapp, MD, Loyd Christensen, BS, Robert Jones, Carlos Lodeiro, BS, Ellen Wicker, DO, William Klingsporn, MD, Alan Tyroch, MD. Texas Tech HSC Paul Foster School of Medicine
Introduction: Barbed sutures were introduced in 2004. Their adoption and use has been widespread across all surgical specialties. One of the infrequent complications seen with the use of barbed sutures are small bowel obstructions. In this study, we perform a systematic review of the literature to characterize small bowel obstructions (SBO) after the use of barbed sutures in a variety of operative procedures.
Methods: A review of the literature was performed by searching PubMed and Ovid. We used the search terms: “barbed” “suture” “bowel” and “obstructions." For each case report we examined the initial surgical procedure, type of barbed suture used, the type of complication, the time to complication, the presentation, and the type of operative interventions required for said complication.
Results: Our review of the literature revealed 18 different cases of small bowel obstruction (SBO) secondary to the use of barbed sutures. The two most index common procedures, with a total of 4 cases each were myomectomy and hysterectomy. The next two most common procedures were TAPP hernia repair and sacral colpopexy. Different types of sutures were reported with the V-Loc barbed suture the most common type, involved in 14 of the 18 cases.
The average time of presentation to SBO was found to be 18.3 days post-op (1-49 days). A total of 15 patients (83.3%) presented with abdominal pain. Other common complaints included vomiting (50%), abdominal distension (27.8%), inability to tolerate food (22.2%) and constipation (16.7%). Most patients had a CT done, with the most common finding being a transition point in the small bowel. A total of 5 cases were also found to have a possible volvulus on CT, and only 1 case was reported to have strangulation.
Of these patients, 14 underwent a diagnostic laparoscopy, 3 of them had a diagnostic laparotomy and one of them had a hepatojejunostomy revision. In most cases, the removal of the redundant barbed suture was enough to release the small bowel and clear the obstruction.
Conclusions: Surgeons should have a high index of suspicion for SBO if a patient presents with obstructive symptoms after a surgery that used barbed sutures. This will often present as a mesenteric volvulus on computed tomography. These particular SBOs require operative exploration, with laparoscopy being successful in the majority of cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91998
Program Number: P006
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster