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A spiral tack as a lead point for volvulus
1St. Luke's-Roosevelt Hospital Center, New York, New York, USA. withers@slrsurgery.org
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|August 3, 2006
Summary
Small bowel volvulus occurred after total extraperitoneal laparoscopic hernia repair due to a tack causing adhesions. This highlights risks associated with tacks in hernia repair.
Area of Science:
- Laparoscopic surgery
- Hernia repair
- Gastrointestinal surgery
Background:
- Total extraperitoneal laparoscopic hernia repair (TEP) is a common procedure.
- Tacks are sometimes used to secure mesh or repair peritoneal defects during TEP.
- Potential complications of TEP include adhesion formation and bowel obstruction.
Observation:
- A 66-year-old male developed an acute abdomen 22 days after bilateral TEP.
- Exploratory laparotomy revealed a small bowel volvulus.
- The volvulus was caused by adhesions to a spiral tack used to repair a peritoneal tear during the initial surgery.
Findings:
- Tack-induced adhesions can lead to serious complications like small bowel volvulus.
- Volvulus can result in compromised blood supply, leading to bowel ischemia and necrosis.
- This case demonstrates an unusual but severe complication of using tacks in TEP.
Implications:
- Reconsideration of tack use in extraperitoneal laparoscopic hernia repairs is warranted.
- Alternative methods like blunt Endoloops or crimps may offer a safer approach for peritoneal repair.
- Careful placement and consideration of foreign body material are crucial to minimize risks such as erosion and adhesion formation.