Ann Surg Treat Res.  2017 May;92(5):380-382. 10.4174/astr.2017.92.5.380.

Postoperative mechanical small bowel obstruction induced by V-Loc barbed absorbable suture after laparoscopic distal gastrectomy

• Jang SH
• Jung YK
• Choi SJ
• Ha TK

• KMID: 2377711
• DOI: http://doi.org/10.4174/astr.2017.92.5.380

Abstract

When performing laparoscopic gastrectomy, suturing the intestinal anastomosis presents one of the greatest challenges. The V-Loc unidirectional barbed suture has been introduced to eliminate the need to tie knots during closure. This device offers a fast, secure, and effective alternative to conventional suture repair during laparoscopic surgery. However, there have been reported cases of surgical complications associated with the use of barbed suture devices. We describe here a case of small bowel obstruction resulting from improper use of barbed suture during total laparoscopic distal gastrectomy performed for gastric cancer. Following diagnosis of small bowel obstruction, the patient underwent immediate laparoscopic repair that identified the cause and relieved the small bowel obstruction. This case highlights the need for surgeons to carefully perform proper suturing technique in order to prevent complications. Surgeons should maintain a high index of suspicion for diagnosing and treating potentially severe complications when using barbed sutures.

Keyword

Laparoscopy; Stomach neoplasms; Intestinal obstruction; Suture techniques; V-loc

MeSH Terms

Diagnosis
Gastrectomy*
Humans
Intestinal Obstruction
Laparoscopy
Stomach Neoplasms
Surgeons
Suture Techniques
Sutures*

Figure

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  Fig. 1 (A) Preoperative contrast enhanced abdomen CT scan showed stomach and duodenal stump dilatation with surgical clip (arrow) right under the anastomosis site. (B) The coronal view of CT scan showed small bowel was rotated on the axis of V-Loc wire end and surgical clip (arrow).

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  Fig. 2 Laparoscopic intraoperative image shows small bowel was internally herniated between V-Loc (Covidien, New Haven, CT, USA) wire end and surgical clip.

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