Background

The use of knotless barbed suture has become increasingly more common, especially in the setting of laparoscopic surgery. The ease of use and greater efficiency have contributed to its increased popularity across multiple specialties. Although not common, bowel obstructions from barbed suture have been reported. We report the first series of barbed suture causing postoperative bowel obstruction after Roux-en-Y gastric bypass (RYGB).

Methods

A single-institution retrospective chart review was performed, and 4 patients were identified that had a postoperative bowel obstruction secondary to barbed suture. In all cases permanent barbed suture was used to close the mesenteric defect at the jejunojejunostomy.

Results

The bowel obstruction in all four patients was secondary to the permanent barbed suture used for jejunojejunostomy mesenteric closure. Time to presentation ranged from 16-334 days post RYGB. All patients were successfully treated with diagnostic laparoscopy and removal of exposed suture. Obstruction was secondary to suture pulling through mesentery (1 patient) or pulling beyond bowel margin and wrapping around Roux limb (3 patients). All patients had an uneventful recovery.

Conclusions

In this small sample size, the LPM integrity is not essential for weight loss after SG when adjusting for age, sex and BMI. Further studies are needed to understand the differences in weight loss among the two groups.