2022 Volume 55 Issue 11 Pages 718-724
An 80-year-old male underwent laparoscopic hernia repair for bilateral internal inguinal hernia. He was discharged on postoperative day (POD) 1; however, on POD 8, he returned to our department with chief complaints of abdominal distension, abdominal pain, and vomiting. He was diagnosed with adhesive intestinal obstruction, but the obstruction did not resolve with conservative management with an ileus tube. He finally underwent laparoscopic reoperation for the obstruction on POD 13. During this procedure, the end of the barbed suture used for peritoneum closure in the hernia repair was found to have migrated into the nearby mesentery of the small bowel and formed a band that directly compressed the terminal ileum and caused small intestinal obstruction. The obstruction was released by cutting and pulling out the free edge of the barbed suture. Neither intestinal resection nor peritoneum reclosure was needed. The patient was discharged on re-POD 5 without any complications. The use of barbed suture is convenient and time-saving, and is used in various surgical departments. However, our case suggests that there is a risk of intestinal obstruction or intestinal volvulus due to barbed suture. Avoiding exposure of the free edge of the barbed suture in the peritoneal cavity, such as cutting the free edge as short as possible or using a non-barbed suture above the barbed suture, might contribute to reduction of these complications.
