REFERENCES

1. Milone M et al. J Laparoendosc Adv Surg Tech 2013;23:9112. Gys B et al. Obes Surg 2017;2:853. Jang SH et al. Ann Surg Treat Res 2017;92:501

Post-operative ileus with knotless barbed sutures V-Loc post bypass surgery: case

report and review of the literature

A. Litchinko, F. Cherbanyk, F. Pugin, B. Egger

Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg

METHODS

A 25-year-old female presented with abdominal painand severe nausea 7 days after laparoscopic gastricBypass for morbid obesity. Clinical examinationrevealed an epigastric tenderness without any sign ofperitonitis and laboratory reults were normal. CT-scanof the abdomen showed severe small bowel obstructionat the level of the Y-connection anastomosis requiring asurgical re-intervention (Fig 1).

CONCLUSION

Barbed sutures have been well evaluated inprospective studies and their efficacy and efficiency arenowadays well established. However, some cases ofsmall bowel obstruction have been reported aftergastric bypass surgery or other operations utilizingsuch barbed sutures.In this particular case, the uncovered part of the threadwas causing a mechanical obstruction which forced usto do a re-intrevention. In order to avoid suchcomplications the tail part of the thread ought to becovered and placed in a safe location when everpossible.

OBJECTIVE

Gastric Bypass is nowadays a well-established and acommon surgical procedure for obese patient.Important steps of this surgery are the gastrointestinalbarbed sutures. V-Loc™ sutures were shown to bequick, secure and effective to perform suchanastomoses. Unidirectional and knotless sutures havegreatly reduced the suturing steps. However, somecomplications have been reported in the literature. Wedescribe here a case of small bowel obstruction causedby a barbed suture performed during laparoscopicgastric Bypass surgery for morbid obesity.

RESULTS

Explorative laparoscopy has been performed revealingan strong adhesion between the tail of the thread andthe omentum causing small bowel obstruction andgastric dilatation (Fig 2a). Careful manipulation of thethe adhesion at the proximal suture permitted to isolateand cut the V-Loc™ tail which solved the problemwithout any further action (Fig 2b).

Figure 1. CT-scan showing small bowel obstruction

Figure 2a. V-Loc™ suture anchored in the omentum

Figure 2b. Final shortening of the barbed suture