Bowel obstruction and perforation secondary to barbed suture after minimally invasive inguinal hernia repair: report of two cases and literature review

Liming Wang,Daitaro Yoshikawa,Taku Maejima,Toru Kono,Shoji Nishihara,Susumu Fukahori

doi:10.1186/s40792-021-01249-w

Liming Wang, Daitaro Yoshikawa + Show 4 more

Open Access

https://doi.org/10.1186/s40792-021-01249-w

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Journal: Surgical case reports	Publication Date: Jul 13, 2021
Citations: 7	License type: open-access

Affiliation: Sapporo Higashi Tokushukai Hospital

Abstract

BackgroundLaparoscopic transabdominal preperitoneal patch (TAPP) is now commonly used in the repair of inguinal hernia. Barbed suture can be a fast and effective method of peritoneal closure. We report two rare cases of small bowel obstruction and perforation caused by barbed suture after TAPP.CasesPatient 1 is a 45-year-old man who underwent laparoscopic repair of a right inguinal hernia. Barbed suture was used to close the peritoneal defect. At 47 days after the operation, he was diagnosed with a small bowel obstruction caused by an elongated tail of the barbed suture. Emergency laparoscopic exploration was performed for removal of the embedded suture and detorsion of the volvulus. The second patient is a 50-year-old man who was admitted with a small bowel perforation one week after TAPP herniorrhaphy. Emergency exploration revealed that the tail of the barbed suture had pierced the small intestine, causing a tiny perforation. After cutting and releasing the redundant tail of the barbed suture, the serosal and muscular defect was closed with 2 absorbable single-knot sutures. Both patients have recovered well. Finally, we searched the PubMed database and reviewed the literature on the effectiveness and safety of barbed suture for TAPP.ConclusionsSurgeons should understand the characteristics of barbed suture and master the technique of peritoneum closure during TAPP in order to reduce the risk of bowel obstruction and perforation.

Highlights

Laparoscopic transabdominal preperitoneal patch (TAPP) is commonly used in the repair of inguinal hernia
Surgeons should understand the characteristics of barbed suture and master the technique of peritoneum closure during TAPP in order to reduce the risk of bowel obstruction and perforation
We present two cases of bowel obstruction and perforation after TAPP repair, which were both related to the barbed suture

Summary

Background

Laparoscopic transabdominal preperitoneal patch (TAPP) is commonly used in the repair of inguinal hernias [1, 2]. We present two cases of bowel obstruction and perforation after TAPP repair, which were both related to the barbed suture. Case 1: bowel strangulation caused by barbed suture A 45-year-old man with swelling in the right groin due to indirect hernia (Fig. 1a). TAPP repair was performed by an experienced surgeon and the peritoneal defect was closed with a 4-0 absorbable monofilament barbed suture (V-locTM, Covidien, Mansfield, MA, USA) from right to left, leaving a residual tail of about 5 mm (Fig. 1b). Emergency laparoscopic exploration revealed that the tail of the barbed suture was much longer and was embedded in the small bowel mesentery, causing volvulus obstruction (Fig. 1e, f ). Case 2: perforation of the small intestine due to the barbed suture A 50-year-old man presented with a preoperative CT diagnosis of a right direct inguinal hernia (Fig. 2a).

Discussion

Conclusion