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Early Postoperative Small Bowel Obstruction associated with the use of V-loc Sutures during Surgery for POP
noted in our second case, there is also the potential for 2. Patri P, Beran C, Stjepanovic J, Sandberg S, Tuchmann A,
the stitch itself to unravel from the peritoneum leading to Christian H. V-loc, a new wound closure device for peritoneal
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stitch exposure. Despite this, based on our findings of closure – is it safe? A comparative study of different perito-
neal closure systems. Surg Innov 2011 Jun;18(2):145-149.
obstruction related to remnant suture ends in all three of 3. Salminen HJ, Tan WS, Jayne DG. Three cases of small bowel
the cases presented here, we would advocate for minimi- obstruction after laparoscopic ventral rectopexy using the
zation of the exposed length of remaining barbed suture. V-loc suture. Tech Coloproctol 2014 Jun;18(6):601-602.
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4. Sakata S, Kabir S, Petersen D, Doudle M, Stevenson AR. Are
CONCLuSiON we burying our heads in the sand? Preventing small bowel
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obstruction from the V-loc suture in laparoscopic ventral
Although our earliest patient presented on postopera- rectopexy. Colorectal Dis 2015 Sep;17(9):180-183.
tive day number 3, obstructive complications after the 5. Thubert T, Pourcher G, Deffieux X. Small bowel volvulus
use of barbed sutures have been reported as early as following peritoneal closure using absorbable knotless device
7
1 day after the initial operation. Surgeons should be during laparoscopic sacral colpopexy. Int Urogynecol J 2011
Jun;22(6):761-763.
judicious in their use of barbed suture devices and 6. Köhler G, Mayer F, Lechner M, Bittner R. Small bowel
should have a high index of suspicion for barbed-suture obstruction after TAPP repair caused by a self-anchoring
related bowel obstruction in the early postoperative barbed suture device for peritoneal closure: case report and
period with the knowledge that these forms of mechani- review of the literature. Hernia 2015 Jun;19(3):389-394.
cal obstruction will likely not be amenable to conserva- 7. Vasudevan SP, Dworkin MJ. Small bowel obstruction
tive management. following laparoscopic ventral mesh rectopexy. Colorectal
Dis 2013 Dec;15(12):1543-1544.
8. Lee ET, Wong FW. Small bowel obstruction from barbed
CLiNiCAL SiGNiFiCANCE
suture following laparoscopic myomectomy: a case report.
While barbed suture materials, such as the V-loc™ suture Int J Surg Case Rep 2015;16:146-149.
allow for easier laparoscopic suturing and potentially 9. Buchs NC. Intestinal obstruction following use of laparoscopic
decreased operative time, exposed suture material barbed suture: a new complication with new material? Minim
Invasive Ther Allied Technol 2011 Sep;21(5):369-371.
may catch on adjacent tissues potentially serving as a 10. Quibel S, Roman H, Marpeau L. Volvulus following barbed
nidus for early mechanical obstruction. It is important suture. Gynecol Obstet Fertil 2012 Jun;40(6):382-383.
for laparoscopic surgeons to be aware of this relatively 11. Vahanian SA, Finamore PS, Lazarou G. Delayed small bowel
unknown potential complication. obstruction after robotic-assisted sacrocolpopexy. Female
Pelvic Med Reconstr Surg 2015 Jan-Feb;21(1):e11-e13.
REFERENCES 12. Api M. Peritoneal closure over barbed suture to prevent
adhesions: a randomized controlled trial in an animal model.
1. Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, J Minim Invasive Gynecol 2015 May-Jun;22(4):619-625.
Wolthuis AM, D’Hoore A. Long-term outcome after 13. Kindinger L, Setchell T, Miskry T. Bowel obstruction due to
laparoscopic ventral mesh rectopexy: an observational study entanglement with unidirectional barbed suture following
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