Barbed suture related small bowel obstruction in bariatric surgery: a case series

Authors

  • Kirra G. Parks Department of Surgery, Wagga Wagga Base Hospital, New South Wales, Australia
  • Nicholas E. Williams Department of Surgery, Wagga Wagga Base Hospital, New South Wales, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20240683

Keywords:

Barbed suture, RYGB, Intestinal obstruction, Bowel obstruction, Bariatric surgery

Abstract

Bariatric surgeries are amongst the most commonly performed yet technically demanding laparoscopic procedures in Australia. The use of barbed suture has been widely adopted for use in gastric bypass surgeries to avoid the need for intracorporeal knot tying while maintaining tension and improving surgical efficiency. Whilst barbed suture has been reported as safe with similar outcomes to traditional suture use in bariatric surgery there is a risk that the barbs on the tail of the suture can grasp other tissues and form band adhesions resulting in small bowel obstruction (SBO). We present a series of four cases of barbed suture related SBO post Roux-en-Y gastric bypass (RYGB) surgery. In all four patients the SBO was caused by a band adhesion related to the tail of the non-absorbable (permanent) barbed suture used to close the mesenteric defect adjacent to the jejunojejunostomy. The time to presentation with SBO ranged from 1 day to 20 months post RYGB and all patients underwent diagnostic laparoscopy where the adhesion was divided and the tail of the suture trimmed. To avoid this uncommon complication, we recommend the use of absorbable barbed suture with two extra passes beyond the completion of the suture line and the tail cut almost flush with the tissue. Further data is needed to determine if the recommended modified technique still poses a risk of SBO or if use of absorbable suture to close the mesenteric defect increases the risk of internal hernia.

References

Medicare Statistics. Medicare Item Reports, 2015. Available at: http://medicarestatistics.humanservices. gov.au/statistics/do.jsp?_program=%2fstatistics%2fmbs_item_standard_report&drill=ag&group=30445%2c+31575%2c+31572%2c+31581%2c+31584&var=services&stat=count&rpt_fmt=by+state&ptype=calyear&start_dt=201601&end_dt=201612. Accessed On 8 February 2024.

Bariatric Surgery Register 2022 Annual Report, 2022. Available at: https://www.monash.edu/ data/assets/pdffile/0018/3351042/bariatric-surgery-registry-annual-report-2022_web.pdf. Accessed On 8 February 2024.

Lin Y, Long Y, Lai S, Zhang Y, Guo Q, Huang J, et al. The Effectiveness and Safety of Barbed Sutures in The Bariatric Surgery: A Systematic Review and Meta-Analysis. Obesity Surg. 2019;29(6):1756-64.

Vidarsson B, Sundbom M, Edholm D. Shorter Overall Operative Time When Barbed Suture Is Used in Primary Laparoscopic Gastric Bypass: A Cohort Study Of 25,006 Cases. Surg Obes Relat Dis. 2017;13(9):1484-8.

Covidien. V-Loctm Absorbable Wound Closure Device Pt00130057. Mansfield, Ma. 2012.

Covidien. V-Loctm Pbt Non-Absorbable Wound Closure Device Pt00095436. Mansfield, Ma. 2013

Verrelst L, Blockhuys M, Hendrickx L, Gypen B, Valk J, Heyman S, et al. Effect of Suture Used for Closure of Mesenteric Defects After Laparoscopic Roux-En-Y Gastric Bypass: Single-Center Study. Obesity Surg. 2023;33(2):506-12.

Clapp B, Klingsporn W, Lodeiro C, Wicker E, Christensen L, Jones R, et al. Small Bowel Obstructions Following the Use of Barbed Suture: A Review of The Literature and Analysis of The Maude Database. Surgical Endoscopy. 2020;34(3):1261-9.

Stabile G, Romano F, De Santo D, Sorrentino F, Nappi L, Cracco F, et al. Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review. Front Surg. 2021;8:626505.

Tyner P, Clifton T, Fenton J. Hand-Sewn Gastrojejunostomy Using Knotless Unidirectional Barbed Absorbable Suture During Laparoscopic Gastric Bypass. Surg Endosc. 2013;27(4):1360-66.

Stenberg E, Ottosson J, Szabo E, Näslund I. Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery-A Register-Based Cohort Study. Obesity Surg. 2019;29(4):1229-35.

Albert T, Vaillant C, Genser L. Early Small Bowel Volvulus After Gastric Bypass: Think About Barbed Sutures! J Visceral Surg. 2021;158(2):187-8.

Esposito C, Intagliata A, Eugenio R, Wheeler A. A098 Trapped Behind Barbs: A Case Series of Small Bowel Obstruction After Roux-En-Y Gastric Bypass. Surg Obesity Rel Dis. 2022;18:S33.

Oor J, De Castro S, Van Wagensveld B. V-Loc Capable of Grasping Surrounding Tissue Causes Obstruction at The Jejunojejunostomy After Roux-En-Y Laparoscopic Gastric Bypass. Asian J Endosc Surg. 2015;8(2):209-11.

Sarhan D, Fathy E, Newira A. An Unusual Case of Early Small Bowel Obstruction After Roux-En-Y Gastric Bypass by The Free End of a V-Loc Suture. Asian J Endosc Surg. 2023;16(2):271-4.

Magouliotis De, George T, Vasiliki St, Grigorios C, Dimitris Z. Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: A Meta-Analysis. Obesity Surg. 2020;30(5):1935-43.

Yao L, Dolo P, Shao Y, Li C, Widjaja J, Hong J, et al. Absorbable Suture Can Be Effectively and Safely Used to Close the Mesenteric Defect in A Gastric Bypass Sprague-Dawley Rat Model. BMC Surg. 2020;20(1):8.

Gumbs A, Duffy J, Chandwani R, Bell R. Jejunojejunal Anastomotic Obstruction Following Laparoscopic Roux-En-Y Gastric Bypass Due to Non-Absorbable Suture: A Report of Seven Cases. Obes Surg. 2006;16(1):12-5.

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Published

2024-03-16

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Section

Case Series