Case report
Small bowel volvulus after transabdominal preperitoneal hernia repair due to improper use of V-Loc™ barbed absorbable wire – do we always “read the instructions first”?

https://doi.org/10.1016/j.ijscr.2015.02.020Get rights and content
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Highlights

  • Serious complications during routinely performed procedures due to improper use of V-Loc™ barbed wire can occur.

  • When used intraabdominally the V-Loc™ barbed absorbable wire needs to be shortened and the suture stump to be extraperitonealized.

  • Surgeons need to be aware of relevant “tricks and traps” of routinely performed procedures.

Abstract

Introduction

Transabdominal preperitoneal endoscopic hernia repair (TAPP) is part of primary surgical health care. While both, the reported recurrence rate and procedure specific morbidity are consistently low, rare serious complications occur.

Presentiation of case

A 36-year-old male patient developed bowel obstruction three days after both-sided TAPP for inguinal hernia repair. A computer tomography scan of the abdomen revealed a small bowel volvulus in the right lower quadrant of the abdomen requiring urgent revisional surgery. Intraoperatively, the small bowel and its mesenterial vessels were found to be twisted around a 5 cm long V-Loc™ barbed absorbable suturing wire. After successful laparoscopic adhesiolysis, removal of the wire and detorquing of the bowel conglomerate, resection of small intestine was not necessary. The patient's further postoperative recovery was uneventful.

Discussion

Due to the barbed configuration of the V-Loc™ wire, a gapless continuous suturing of the peritoneum without laparoscopic knotting is easily and fast to accomplish. In this case the recommendation of the manufacturer to shorten the wire was not strictly followed and neither had the suture stump been extraperitonealized in order to avoid such rare complications.

Conclusion

Surgeons need to be aware of relevant “tricks and traps” of routinely performed procedures and have to know all tools and material they use very well. This case may therefore increase our attention when it comes to little things which actually do matter.

Keywords

Transabdominal perperitoneal hernia repair
TAPP
V-Loc™ wire
Small bowel volvulus

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