Barbed suture related small bowel obstruction in bariatric surgery: a case series

Abstract

Bariatric surgeries are amongst the most commonly performed yet technically demanding laparoscopic procedures in Australia. The use of barbed suture has been widely adopted for use in gastric bypass surgeries to avoid the need for intracorporeal knot tying while maintaining tension and improving surgical efficiency. Whilst barbed suture has been reported as safe with similar outcomes to traditional suture use in bariatric surgery there is a risk that the barbs on the tail of the suture can grasp other tissues and form band adhesions resulting in small bowel obstruction (SBO). We present a series of four cases of barbed suture related SBO post Roux-en-Y gastric bypass (RYGB) surgery. In all four patients the SBO was caused by a band adhesion related to the tail of the non-absorbable (permanent) barbed suture used to close the mesenteric defect adjacent to the jejunojejunostomy. The time to presentation with SBO ranged from 1 day to 20 months post RYGB and all patients underwent diagnostic laparoscopy where the adhesion was divided and the tail of the suture trimmed. To avoid this uncommon complication, we recommend the use of absorbable barbed suture with two extra passes beyond the completion of the suture line and the tail cut almost flush with the tissue. Further data is needed to determine if the recommended modified technique still poses a risk of SBO or if use of absorbable suture to close the mesenteric defect increases the risk of internal hernia.