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WJOLS

John Tillou et al 10.5005/jp-journals-10033-1281
CaSe RepORt

Early Postoperative Small Bowel Obstruction associated

with the use of V-loc™ Sutures during Surgery for Pelvic
Organ Prolapse

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1 John Tillou, Roger Eduardo, Deborah Nagle, Thomas Cataldo, Janet Li, Roger Lefevre, Vitaliy Poylin
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ABSTRACT iNTRODuCTiON
Aims: To describe three cases of early postoperative bowel Minimally invasive surgical approaches are being
obstruction after use of barbed suture material during surgery employed more frequently in the treatment of pelvic organ
for pelvic organ prolapse (POP).
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prolapse (POP). The V-loc™ suture (Covidien, Mansfield,
Introduction: The utilization of minimally invasive surgical MA, USA), a unidirectional, barbed, self-anchoring
techniques for the treatment of POP is increasing, with a suture, available in either absorbable or nonabsorbable
subsequent increase in the use of barbed, self-anchoring
suture material, such as the V-loc™ suture, which facilitates forms, is frequently utilized during the performance
intracorporeal suturing. of maneuvers which require intracorporeal suturing,
such as peritoneal closure or sutured rectopexy. The
Case report: We present three cases of early postoperative
small bowel obstruction related to the use of barbed sutures advantage of the V-loc™ suture is that multiple rows of
during minimally invasive surgery for POP, as well as a review barbs allow for the creation of a self-anchoring, running
of the relevant literature. closure without the need for intracorporeal knots. This
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Conclusion: Surgeons should use barbed suture material allows for easier laparoscopic suturing and potentially
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judiciously and should have a high index of suspicion for barbed- decreased operative times. When using this type of
suture related mechanical obstructions. These obstructions are barbed suture, it is considered common practice to leave
not likely to resolve with conservative management. several centimeters of the cut end of the stitch exposed in
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Clinical significance: Barbed suture materials allow for ease order to prevent potential tissue slippage. However, as
of laparoscopic suturing but carry a risk of contributing to early has been demonstrated in several recent case reports, 4-10 a
bowel obstruction. Laparoscopic surgeons should be aware of potential downside to this practice and to the use of such
this relatively unknown potential complication.
suture material is that exposed suture barbs may catch on
Keywords: Bowel obstruction, Case report, Prolapse, Surgery, adjacent small bowel, mesentery, or omentum leading to
Suture. serosal injury, obstruction, or volvulus. Here, we report

How to cite this article: Tillou J, Eduardo R, Nagle D, three such cases of small bowel obstruction in the early
Cataldo T, Li J, Lefevre R, Poylin V. Early Postoperative Small postoperative period related to the use of V-loc™ sutures
Bowel Obstruction associated with the use of V-loc™ Sutures during minimally invasive POP surgery.
during Surgery for Pelvic Organ Prolapse. World J Lap Surg
2016;9(2):94-97.
CASE REPORTS
Source of support: Nil
Case 1
Conflict of interest: None
A 53-year-old female with a 1-year history of full thick-
ness, reducible rectal prolapse underwent a robotic
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1,2 Resident, Chief, 4,6,7 Surgeon, Section Head rectopexy. The rectopexy was performed using 2-0
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1-4,7 Division of Colon and Rectal Surgery, Beth Israel Deaconess nonabsorbable V-loc™ sutures on both sides of the sacrum
Medical Center, Boston, Massachusetts, USA at the level of S3, and the pelvic peritoneum was closed
5 Divison of Urogynecology, Beth Israel Deaconess Medical in a running fashion using an additional absorbable
Center, Boston, Massachusetts, USA 2-0 V-loc™ stitch. On postoperative day number 25, she
presented with a several-day history of abdominal pain,
6 Division of Female Pelvic Medicine and Reconstructive Surgery
Beth Israel Deaconess Medical Center, Boston Massachusetts distention, emesis, and failure to pass flatus. A computed
USA tomography (CT) scan was notable for a small bowel
Corresponding Author: Vitaliy Poylin, Surgeon, Division of obstruction with a transition point in the distal ileum at
Colon and Rectal Surgery, Beth Israel Deaconess Medical the level of the rectopexy (Fig. 1). She was subsequently
Center, Boston, Massachusetts, USA, Phone: +6176674159 taken for a diagnostic laparoscopy, which revealed an
e-mail: vpoylin@bidmc.harvard.edu
adhesive band, entrapping the distal ileum, attached to
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