SMALL BOWEL OBSTRUCTION AS A COMPLICATION OF TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR – AN INTERNAL HERNIA CAUSED BY ADHESIONS TO A BARBED SUTURE

Abstract

Abstract Background Laparoscopic approach to inguinal hernias is advantageous as it reduces postoperative pain, length of stay and recovery time, while allowing for an easier correction of multiple hernia defects in a single operation. Laparoscopic transabdominal preperitoneal (TAPP) hernioplasty is one such technique. Bowel obstruction as a postoperative complication is rare, and can be due to inadequate peritoneal closure, herniation through disrupted peritoneum or adhesions. Aim We herein report on a case of postoperative small bowel obstruction caused by adhesions to a long, barbed suture. Material and Methods Case presentation, in video format, of a 74-year-old man admitted through the emergency department for small bowel obstruction, 7 days after laparoscopic bilateral TAPP hernioplasty and intraperitoneal underlay mesh (IPUM+) hernioplasty for correction of bilateral inguinal hernia and umbilical hernia. Results After examination, and an inconclusive computerised tomography scan, the patient underwent emergency laparoscopic exploration. We found a small bowel obstruction caused by adhesions to the barbed suture previously used to close the peritoneal flap on the right side. The small bowel was freed from the suture, without need for its resection. Appendicectomy was performed as well. The patient was discharged 3 days later, without further complications. Conclusions Adhesions after peritoneal closure may lead to postoperative small bowel obstruction. Surgeons must be aware of complications associated with any procedures performed, including the rare, since a timely diagnosis is necessary for their patients’ adequate care. Hernia surgeons can minimise this complication by improving their suture technique and avoiding bridges of exposed barbed sutures.