POSTOPERATIVE MECHANICAL SMALL BOWEL OBSTRUCTION INDUCED BY UNIDIRECTIONAL BARBED SUTURE: A CASE REPORT

Objectives: Unidirectional barbed suture (UBS) has been introduced to eliminate the need to tie knots during surgical procedures. This device offers a fast, secure, and effective alternative to conventional suture repair during minimally invasive surgery. However, there have been reported cases of surgical complications including bowel occlusion associated with the use of UBS. We present a case of progressive small bowel obstruction secondary to UBS that highlights the need for attention to detailed suturing technique to prevent complication. Surgeons should maintain a high index of suspicion for diagnosing and treating potentially severe complications when using UBS. These may occur early and be treated less conservatively than traditional early small bowel obstruction.

A 44-year-old normal-weight female with a complex gynecological history including endometriosis with prior total abdominal hysterectomy, dyspareunia, and interstitial cystitis underwent robotic lysis of adhesions, bilateral oophorectomy, and presacral neurectomy approximately two weeks before presenting to our emergency room. She was doing well at her initial postoperative appointment with her gynecologist, but subsequently developed signs and symptoms of partial small bowel obstruction. She was admitted to the hospital twice within one week and resolved symptoms with bowel rest and nasogastric suction. She presented a third time with intractable nausea, vomiting, and obstipation. After a discussion of options, the patient requested laparoscopic exploration for relief of small bowel obstruction. Near the terminal ileum, a dense adhesion was noted to the gynecological surgical site causing obstructive symptoms with decompressed ileum beyond it. In the process of gently lysing this adhesion, it was found to contain redundant UBS tail which attached to the ileum causing a kink. We were able to gently retract the bowel off the suture without causing perforation. The suture tail was truncated to a level of no identifiable excess. The patient resolved symptoms thereafter and was discharged home on postoperative day two tolerating a diet with passage of flatus and stool.

New surgical devices and materials can enhance surgical practice and benefit patients. When utilizing UBS, surgeons must maintain awareness of proper usage and potential hazards while exercising attention to technical details such as length of the suture tail, use of adhesive barriers, or performing a few sutures backwards to avoid complications. Further studies may be useful to assess whether avoidance of barbed suture application on serosal surfaces may prevent these complications.

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