Adhesive Bands Research Articles

Comparison of frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing transurethral resection of prostate with and without postoperative catheter traction.

Objective: To determine and to compare the frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing TURP with and without postoperative catheter traction. Study Design: Analytical Cross Sectional Study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Dec 2023 to March 2024. Methods: After ERC approval & informed consent a total of 48 patients with comparable baseline characteristics such as age and preoperative prostate size who underwent TURP and were having significant postoperative hematuria (≥ grade 2 on a standardized hematuria colorimetric card) were enrolled in the study & were divided into two groups i.e. group A and group B, each having 24 patients. Group A patients were subjected to postoperative catheter traction with thigh using an adhesive band that was maintained over the night, while group B patients were not subjected to this postoperative intervention. Patients of both the groups received a single shot of IM diclofenac sodium 75mg in the recovery room and later on oral diclofenac sodium 50mg was given twice a day. All Patients were presented with a visual analogue scale (VAS) every 6 hourly during the first 24 hours postoperatively and were given additional IM diclofenac sodium 75mg if the reported pain was of moderate-severe intensity as indicated by the VAS score and an entry was made on the pro forma. Also, at the time of discharge total days spent in the hospital by patients of both the groups after undergoing TURP and any postoperative complications were noted. Results: 79.16% of group A patients required additional postoperative analgesia as compared to a value of 29.16% of group B patients (p= 0.0001). The mean hospital stay of group A and group B was 4.04 ± 0.65 days and 3.25 ± 0.65 days respectively (p=0.0001).

Laparoscopic Management of Acute Small Bowel Obstruction: A Retrospective Study at a Tertiary Center in the United Kingdom.

Objectives To present a single-center experience of laparoscopic management of acute small bowel obstruction (ASBO) based on seven years of data and demonstrate its suitability for the United Kingdom (UK). Methods A retrospective review of case notes to evaluate postoperative outcomes was conducted. All emergency small bowel obstructions treated laparoscopically were included. The cases that were converted to a laparotomy were excluded. Demographics (age, sex), American Society of Anesthesiologists (ASA) grade, indication for surgery, duration of stay, complications, requirement of stoma, requirement of intensive treatment unit/high dependency unit (ITU/HDU), reoperation/readmissions, and 30-day mortality were noted. The results were tabulated and analyzed accordingly. Results There were 119 patients studied, with a median age of 66 (range: 17-97). The sex ratio was 62 females to 57 males. Primary etiologies of adhesion bands (49.5%, 59) and hernia (31.9%, 38) werethe most common. Minor and majorcomplications were 15 (12.6%) and 37 (31%),respectively. Three (2.5%) patients passed away within 30 days of surgery. The medianlength of stay (LOS) was eight days. ThemedianLOS subgroup analysis showed nine days for adhesiolysis and six days for hernias. Discussion This study shows that there is significant heterogeneity in outcomes regarding small bowel obstruction around the world. We have demonstrated similar to better results in our center relative to other prominent centers in the UK. This can be attributed to the patient cohort, presentation, and physiological status on admission, delay to surgery, and associated co-morbidities to name a few. Conclusion This study indicates that laparoscopic surgery is a safe approach to treating ASBO, provided adequate expertise and infrastructure are available.

The Therapeutic Potential of Metformin for Attenuating Postsurgical Adhesion Band Formation

Objectives: Intra-abdominal adhesions are the most frequently occurring postoperative complication following abdominopelvic surgery. Peritoneal adhesion formation can lead to infertility, chronic pelvic pain, and intestinal obstruction. Several studies have shown the potential role of metformin in reducing inflammation. Here, we explored the therapeutic potency of Metformin against postsurgical adhesion band formation. Methods: We adopted Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines for the experimental protocol. Peritoneal adhesions were examined macroscopically .Metformin (100 mg/kg) was administered intraperitoneally in male albino Wistar rats. After 9 days, macroscopic evidence and score of fibrotic bands based on scaling methods were performed and evaluated by the Nair and Leach scoring system. Moreover, the anti-inflammatory and antifibrosis effects were investigated by using hematoxylin and eosin, Masson's trichrome staining, the enzyme-linked immunosorbent assay (ELISA), and reverse transcription polymerase chain reaction (RT-PCR). Results: Metformin inhibited the stabilization of adhesion bands and appeared to elicit antiinflammatory responses by attenuating submucosal edema, suppressing proinflammatory cytokines, decreasing proinflammatory cell infiltration, and inhibiting oxidative stress at the site of peritoneal surgery. We also showed that metformin prevents fibrotic adhesion band formation by reducing excessive collagen deposition and suppression of profibrotic gene expression at the peritoneum adhesion tissues via modulation of Col 1A1/A3. Conclusion: These results supported the potential application of metformin in preventing postsurgical adhesion band formation by inhibiting key pathologic responses of inflammation and fibrosis in patients post-surgery.

Oenothera biennis improves pregnancy outcomes by suppressing inflammation and fibrosis in an intra-uterine adhesion rat model

Intrauterine adhesion (IUA), also referred to as Asherman’s syndrome, is characterized by fibrosis, inflammation, and can cause amenorrhea and infertility due to abnormal endometrial healing. Histological and Molecular methods were used to evaluate the efficacy of EPO, which is traditionally known for its anti-inflammatory and fibrinolytic properties, in preventing the formation of IUA. Oral administration of EPO reduced the formation of adhesion bands and promoted endometrial regeneration. EPO administration decreased extracellular matrix accumulation, evidenced by the down-regulation of tissue COL1A1 and COL3A1 expression. The anti-inflammatory effect of EPO was confirmed by a reduction in oxidants and down-regulation of pro-inflammatory cytokines including TNF-α, IL-6, IFN-γ, and IL-1β. Furthermore, EPO improved embryonic development parameters, including size and weight of embryo, as well as increased embryo count and live embryo percentage in the rat IUA model. EPO also positively enhanced implantation markers, particularly enlargement and mass gain in the placenta of the treated group, consequently improving pregnancy outcomes such as the number of babies, percent of live babies, baby weight and gestation time. Histopathological investigation provides evidence that oral administration of EPO showed no toxicity on the main three organs including liver, kidney and heart. These results showed that EPO can be considered as a safe and natural product with potent anti-inflammatory and fibrinolytic properties without any observed side effects for the treatment of IUA.

Concurrent presentation of unrelated perforated appendicitis and high-grade small bowel obstruction: A case report

Small bowel obstruction and acute perforated appendicitis are common surgical problems independently. At times, acute appendicitis may present with small bowel obstruction due to the localized inflammatory process. This results in mechanical small bowel obstruction usually near the terminal ileum. However, it is extremely rare to have both abdominal processes occurring simultaneously, but not related to one another. In this study, we present a case of a healthy 62-year-old female patient who had concurrent high-grade small bowel obstruction due to a chronic adhesive band and perforated appendicitis, seemingly completely independent of each other.

EP187 - Can appendiceal adhesions cause small bowel obstruction? A rare case presentation managed laparoscopically

Abstract Aims Adhesions are the commonest cause of small bowel obstruction world-wide. However, a band adhesion from the appendicular tip to the small bowel causing small bowel obstruction is rarely reported in literature. We report such a presentation and successful management by laparoscopic approach with good outcome. Methods 61-year-old female, presented with abdominal pain, mild distension & vomiting for 3-days. She had undergone ultrasound-guided-drainage of appendicular abscess 3-months ago. CTAP showed small-bowel obstruction with transition point in pelvis - possible cause being adhesions. After initial conservative management, since she was not improving for 2-days, she was consented for diagnostic laparoscopy. Results Intraoperatively, an adhesive band was found between the appendicular tip and distal ileum around 100cm proximal to Ileo-colic junction, resulting in mechanical bowel obstruction. Laparoscopic division of band was performed followed by appendicectomy, and patient had an uneventful recovery and discharged on post-operative day-2. Conclusion Though an uncommon cause of adhesive small bowel obstruction, a band from appendicular tip causing mechanical bowel obstruction can be managed effectively by laparoscopic approach. In future when dealing with complications of appendicitis, like appendicular abscess - it needs to be addressed with clinical suspicion in such presentations.

FP7.2 - Single centre experience of laparoscopic management of acute small bowel obstruction

Abstract Objectives The objective of this article is to present a single-centre experience of laparoscopic emergency surgery reporting outcomes by laparoscopic management of acute small bowel obstruction (ASBO). Methods A retrospective review of case notes to evaluate postoperative outcomes. 119 patients were included in this study of laparoscopic management of ASBO and data analysis was performed with SPSS software. Results There were 119 patients with primary aetiologies of adhesion bands (49.5%/59) and hernia (31.9%/38) were noted. Mortality and morbidity outcomes – 15 patients had minor complications, 37 had major complications and 3 patients had post-operative mortality. The average length of stay (LOS) was 10.86 days. The LOS Subgroup analysis showed that 13.8 days were average for adhesiolysis and 6.7 days for the hernia. Discussion On comparison with the published data global data suggest minor complications of 12.6 % (14% in this single-centre experience), major complications of 34 % (31 % in this single-centre experience) and mortality of 0.6% (2.5 % in this single-centre experience). Conclusion This study shows that this centre has comparable mortality and morbidity outcomes when compared to the global trend, but these outcomes.

The Therapeutic Potential of Ganoderma lucidum Karst and Ziziphus jujuba Mill for Postsurgical Adhesion Band Formation

Background: Intra-abdominal adhesions are a commonly occurring postoperative complication following abdominopelvic surgery. Peritoneal adhesion formation can lead to infertility, chronic pelvic pain, and intestinal obstruction. The anti-inflammatory and anti-oxidant activities of Ganoderma lucidum Karst (G. lucidum) and Ziziphus jujuba Mill (Z. jujuba) have been reported. Here, we have explored the therapeutic potential of Ganoderma lucidum Karst (G. lucidum) and Z. jujuba against postsurgical adhesion band formation. The NC3Rs ARRIVE guidelines were followed during experimental studies. Methods: G. lucidum powder (800 mg/kg) and Z. jujuba powder (400 mg/kg) were administered using oral gavage to different groups of male albino Wistar rats. After ten days of treatment, macroscopic evidence for peritoneal adhesions and adhesion band score were determined. Furthermore, the anti-inflammatory and antifibrosis effects of G. lucidum and Z. jujuba were assessed using histopathology, ELISA, and real-time polymerase chain reaction methods. Also, alterations in some oxidative stress parameters were evaluated. Results: G. lucidum and Z. jujuba significantly decreased adhesion bands and were associated with a reduction in inflammatory cell infiltration into damaged tissues and the mRNA and protein expression of inflammatory cytokines via modulation of TNF-α, IL-6, IL-1β, and TGF-β. Moreover, both agents inhibited fibrotic adhesion band formation by decreasing collagen deposition and reducing profibrotic marker expression, Col1A1, at the peritoneum adhesion tissues. G. lucidum and Z. jujuba improved some antioxidant factors in rats’ adhesion tissues. The result of LC-MS showed that Ganoderma lucidum Karst and Ziziphus jujuba Mill consist of components with antioxidant activity, including ganoderic acid, lucidenic acid, quercetin, linoleic acid, malic acid, and benzoic acid. Conclusion: The results have demonstrated the therapeutic potential of G. lucidum and Z. jujuba in reducing peritoneal adhesion through anti-inflammatory and anti-fibrotic properties, indicating their promising value as a new therapeutic approach in preventing postsurgical adhesion.

Targeting Angiotensin-converting Enzyme Inhibitor via Enalapril Reduces Postsurgical Adhesion Band Formation

Background: Postoperative adhesions commonly occur after abdominal surgery and can lead to significant complications. There is increasing evidence that targeting the renin-angiotensin system (RAS) can reduce inflammation and fibrosis. This study investigates the therapeutic potential of enalapril, an RAS inhibitor, in a rat model of postsurgical adhesion band formation. Methods: A total of 12 male albino Wistar rats received intraperitoneal administration of enalapril (10 mg/kg). After 9 days, the anti-inflammatory and antifibrotic effects were evaluated using RTPCR and ELISA, alongside hematoxylin and eosin and Masson's trichrome staining. Result: The statistical analysis of findings showed that enalapril significantly reduced the frequency and stability of adhesion bands. It attenuated submucosal edema by suppressing pro-inflammatory cytokines, decreasing pro-inflammatory cell infiltration, and inhibiting oxidative stress at the peritoneal surgery site. Additionally, enalapril inhibited fibrotic adhesion band formation by reducing collagen deposition and suppressing the expression of profibrotic genes in peritoneal adhesion tissues. Conclusion: These findings demonstrate the therapeutic potential of enalapril in preventing postsurgical adhesion band formation by inhibiting key pathological responses of inflammation and fibrosis, supporting its use as a preventive treatment in postoperative adhesion management.

A comparative study on antibacterial properties of EuO, CuO, and ZnO dopped ZrO2 sol-gel coatings

ZnO, CuO, and EuO doped ZrO2 films were prepared using a sol-gel dip coating technique, and the effects of the doping on the film thickness, crystallite size, surface roughness, band gap energy, adhesion strength, and antibacterial properties of the coatings were investigated. It was found that the addition of small amounts of ZnO and EuO can significantly improve the uniforminty of the sol-gel coating, while the greater the difference in the coefficients of thermal expansion (CTEs) of the coating and the substrate, the higher the probability of developing surface microcracks. The XRD patterns of the coatings synthesized based on ZrO2 as well as EuO, ZnO, and CuO dopants showed that the ZrO2 structure was tetragonal for all of the compounds. In addition, it was revealed that with an increase in the calcination temperature, the crystallite sizes of the coatings containing ZrO2 and ZnO increased, and in contrast, the crystallite sizes of ZrO2:ZnO, ZrO2:ZnO,CuO and ZrO2:ZnO,EuO compounds decreased. The evaluation of the reflectance of visible light functions showed that adding 30 % ZnO led to a decrease in the band gap energy from 3.19 eV for ZnO2 to 3.01 eV for ZrO2 + 30 % ZnO. Moreover, the lowest band gap energy (2.81 eV) was achieved for the compound containing EuO. Finally, it was concluded that the ZrO2:ZnO,EuO sol-gel coating with the least band gap energy shows better antibacterial activity.

Small Bowel Obstruction Following Congenital Diaphragmatic Hernia Repair-Incidence and Risk Factors.

Small bowel obstruction (SBO) is a known complication following congenital diaphragmatic hernia (CDH) repair, resulting in significant morbidity and potential mortality. Our study aims to evaluate the incidence and risk factors for SBO following CDH repair. A single-institution retrospective review evaluated all CDH births between January 2010 and September 2022 (n = 120). Risk factors for SBO were analyzed, including operative approach, type of repair, need for extracorporeal membrane oxygenation (ECMO), and additional abdominal surgeries (gastrostomy tube and fundoplication). 120 patients were included. 16 (13%) patients developed an SBO, of which 94% were due to adhesive bands. The median time to SBO was 7.5 months. 15/16 (94%) patients required operative intervention. Need for ECMO (P < 0.01), prior gastrostomy tube (P < 0.01), and prior fundoplication (P < 0.01) were associated with an increased risk of SBO, as were longer time to initial CDH repair (6 days vs 3days; P < 0.01) and longer length of initial hospitalization (63 days vs 29days; P = 0.01). Neonates with increased acuity of illness (ie, those requiring ECMO, additional abdominal operations, longer time to repair, and longer initial hospitalizations) appear to have an increased risk of developing adhesive SBO after CDH repair. More than 90% of patients who developed SBO required surgery.

Small bowel torsion due to adhesive band, causing blind loop in pregnancy and the prompt salvage: A case report

Small bowel torsion due to adhesive band, causing blind loop in pregnancy and the prompt salvage: A case report

Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias: a retrospective study

IntroductionTo explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children.MethodsA retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed.ResultsForty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with “cross sign” as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%.DiscussionIAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.

Crocin elicits potent anti-inflammatory and fibrinolytic properties post tendon injury, A new molecule for adhesion therapy

BackgroundPost-surgical tendon adhesion formation is a frequent clinical complication with limited treatment options. The aim of this study is to investigate safety and efficacy of orally administration of crocin in attenuating post-operative tendon-sheath adhesion bands in an Achilles tendon rat model. MethodsStructural, mechanical, histological, and biochemical properties of Achilles tendons were analyzed in the presence and absence of crocin. Inflammation and total fibrosis of tendon tissues were graded between groups using macroscopic and histological scoring methods. ResultsCrocin significantly alleviated the severity, length, and density of Achilles tendon adhesions. Moreover, the recruitment of inflammatory cells and inflammation were significantly decreased in post-operative tissue samples of the crocin-treated group, as quantified with Moran scoring system. Histological results showed that crocin elicited a potent anti-fibrotic effect on tendon tissue samples as visualized by decreasing quantity, quality, grading of fibers, and collagen deposition at the site of surgery when scored either by Tang or Ishiyama grading systems. The H&E staining showed no histo-pathological changes or damage to heart, kidney, and liver tissues of treated rats. ConclusionOur results showed that crocin is a safe effective therapeutic candidate with potent anti-inflammatory and anti-fibrotic properties for adhesion band therapy post tendon surgery.

Advancing Novel Strategies against Post-surgical Tendon Adhesion Bands, Exploring New Frontiers.

Current interest in adhesion formation stems from its global impact on the function and quality of life, spanning a spectrum of subtle impairments to significant disabilities, based on the affected area and the extent of adhesion. Yet therapeutic agents are restricted to prophylactic anti-inflammatories, revision surgeries, and biological and physical techniques, none of which grant a decent outcome. Recent advancements in tissue- engineered biomaterials, drug delivery systems, and fabricating technologies such as nanoparticles, hydrogels, and weaving or braiding demonstrate potential for improved outcomes. However, none of the mentioned methods have reliable outcomes, thus this study aims to elucidate the mechanisms involved in the pathophysiology of tendon adhesion and post-surgical adhesion band formation (PSAB), with a closer look at inflammatory pathways stimulating the process. This article consolidates information on diverse therapeutic and prophylactic methods and cutting-edge technologies, aiming to provide a comprehensive update on this topic, and providing researchers an avenue for new and innovative ideas for further investigations.

Avastin‐Loaded 3D‐Printed Alginate Scaffold as an Effective Antiadhesive Barrier to Prevent Postsurgical Adhesion Bands Formation

Avastin‐Loaded 3D‐Printed Alginate Scaffold as an Effective Antiadhesive Barrier to Prevent Postsurgical Adhesion Bands Formation

The Effects of Trigonella Foenum-graecum L. on Post-surgical Adhesion Band Formation

Background: Intra-abdominal adhesions are severe complications which occur after abdominal surgery. Currently, no specific anti-adhesive medications can completely prevent Intra-abdominal adhesion formation. Therefore, recent studies are exploring new approaches for preventing this complication. Anti-inflammatory properties of Trigonella Foenum-graecum L. (Fenugreek) have been reported in various studies. In this experiment, a murine model was used to evaluate the potential anti-adhesive activity of Fenugreek in vivo. Objective: This experiment aimed to examine the anti-adhesive activity of Fenugreek in the prevention of postsurgical Intra-abdominal adhesions. Methods: We have adhered to the ARRIVE guidelines during these experimental studies. After abdominal surgery, for nine days, Fenugreek (400 mg/kg) was given by gavage to male Wistar rats (n = 6). Following that, all animals were sacrificed to assess the anti-inflammatory and anti-fibrotic effects of Fenugreek using Hematoxylin &amp; eosin staining and Masson’s trichrome staining. Results: Our results showed that Fenugreek hydro-alcoholic extract could significantly reduce the adhesion band formation based on Nair and Leach Scoring system (P &lt; 0.01). The histological assessment also represented less inflammatory cell infiltration and less collagen deposition in the treatment group than in the positive control group (P &lt; 0.01). Conclusion: This study showed that Fenugreek extract could attenuate post-surgical adhesion band formation by inhibiting pathological responses (Inflammation and fibrosis) following surgery.

The Assessment of CDX1, IHH, SHH, GATA4, FOXA2, FOXF1 in Congenital Intra-Abdominal Adhesions.

Congenital abdominal adhesions are a rare condition that can result in a small bowel obstruction at any age, more frequently in pediatric populations. The cause remains unknown, and the importance of aberrant congenital bands is related to the difficulty of diagnosis, and cases of death with late detection have been documented. This research examines the expression of Caudal Type Homeobox 1 (CDX1), Indian Hedgehog (IHH), Sonic Hedgehog (SHH), GATA Binding Protein 4 (GATA4), Forkhead Box A2 (FOXA2) and Forkhead Box F1 (FOXF1) gene expression in human abdominal congenital adhesion fibroblast and endothelium cells by chromogenic in situ hybridization, with the aim of elucidating their potential association with the etiology of congenital intra-abdominal adhesion band development. The potential genes' signals were examined using a semi-quantitative approach. Significant correlations were observed between the expression of CDX1 (p <.001) and SHH (p=0.032) genes in fibroblasts from congenital intra-abdominal adhesions compared to fibroblasts from control peritoneal tissue. Statistically significant very strong correlations were found between the CDX1 and IHH comparing endothelium and fibroblast cells in congenital abdominal adhesion bands. There was no statistically significant difference found in the distribution of IHH, FOXA2, GATA4, and FOXF1 between the fibroblasts and endothelium of the patients compared to the control group. The presence of notable distinctions and diverse associations suggests the potential involvement of numerous morpho-pathogenetic processes in the development of intraabdominal adhesions.

Comparison of the effect of Everolimus, Prednisolone, and a combination of both on experimentally induced peritoneal adhesions in rats

Postoperative intra-abdominal adhesions represent a significant post-surgical problem. Its complications can cause a considerable clinical and cost burden. Herein, our study aimed to investigate the effect of Everolimus on peritoneal adhesion formation after inducing adhesions in rats. In this experimental study, adhesion bands were induced by intraperitoneal injection of 3 ml of 10% sterile talc solution in 64 male albino rats. The first group served as the control group. The second one received oral Prednisolone (1 mg/kg/day), the third received Everolimus (0.1 mg/kg/day), and group four received both drugs with similar dosages for four consecutive weeks. The formation of adhesion bands was qualitatively graded according to the Nair classification. The rats in the control group had extensive adhesions between the abdominal wall and the organs. Regarding substantial adhesion formation, 50% (8/16) of animals in the control group had substantial adhesions, while this rate in the groups receiving Prednisolone, Everolimus, and combination treatment was 31%, 31%, and 31%, respectively. Also, 68.75% (5/11) of the Prednisolone recipients had insubstantial adhesions, the same as Everolimus recipients, while in the combination group, 66.66% (10/15) rats had insubstantial adhesions. Everolimus demonstrated satisfactory results in reducing the rates of induced peritoneal adhesion in an experimental model, similar to Prednisolone and superior to a combination regime.

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

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.