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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Small bowel volvulus after transabdominal preperitoneal hernia repair due to improper use of V-Loc™ barbed absorbable
Joerg Filser1, Joachim Reibetanz1, Katica Krajinovic1
1Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
Insights
A rare complication of transabdominal preperitoneal endoscopic hernia repair (TAPP) involved a V-Loc™ barbed suture causing small bowel obstruction. Awareness of surgical material and techniques is crucial to prevent such serious events.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Transabdominal preperitoneal endoscopic hernia repair (TAPP) is a common surgical procedure.
- While generally safe, rare but serious complications can occur.
Purpose of the Study:
- To report a unique case of small bowel obstruction following TAPP.
- To highlight potential risks associated with barbed suture materials in TAPP.
Main Methods:
- Case report of a 36-year-old male patient.
- Diagnosis via CT scan revealing small bowel volvulus.
- Surgical intervention included laparoscopic adhesiolysis and V-Loc™ wire removal.
Main Results:
- The patient experienced a small bowel volvulus secondary to a V-Loc™ barbed suture.
- Successful laparoscopic detorsion and wire removal without intestinal resection.
- Uneventful postoperative recovery.
Conclusions:
- Barbed sutures like V-Loc™ can cause rare complications if not managed according to manufacturer guidelines.
- Surgeons must be vigilant regarding surgical tools and techniques to prevent adverse events.
Introduction:
Transabdominal preperitoneal endoscopic hernia repair (TAPP) is part of primary surgical health care. While both, the reported recurrence rate and procedure specific morbidity are consistently low, rare serious complications occur.
Presentiation Of Case:
A 36-year-old male patient developed bowel obstruction three days after both-sided TAPP for inguinal hernia repair. A computer tomography scan of the abdomen revealed a small bowel volvulus in the right lower quadrant of the abdomen requiring urgent revisional surgery. Intraoperatively, the small bowel and its mesenterial vessels were found to be twisted around a 5cm long V-Loc™ barbed absorbable suturing wire. After successful laparoscopic adhesiolysis, removal of the wire and detorquing of the bowel conglomerate, resection of small intestine was not necessary. The patient's further postoperative recovery was uneventful.
Discussion:
Due to the barbed configuration of the V-Loc™ wire, a gapless continuous suturing of the peritoneum without laparoscopic knotting is easily and fast to accomplish. In this case the recommendation of the manufacturer to shorten the wire was not strictly followed and neither had the suture stump been extraperitonealized in order to avoid such rare complications.
Conclusion:
Surgeons need to be aware of relevant "tricks and traps" of routinely performed procedures and have to know all tools and material they use very well. This case may therefore increase our attention when it comes to little things which actually do matter.
