Wang Liming, Maejima Taku, Fukahori Susumu, Nishihara Shoji, Yoshikawa Daitaro, Kono Toru
Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
Surg Case Rep. 2021 Jul 13;7(1):161. doi: 10.1186/s40792-021-01249-w.
Laparoscopic transabdominal preperitoneal patch (TAPP) is now commonly used in the repair of inguinal hernia. Barbed suture can be a fast and effective method of peritoneal closure. We report two rare cases of small bowel obstruction and perforation caused by barbed suture after TAPP.
Patient 1 is a 45-year-old man who underwent laparoscopic repair of a right inguinal hernia. Barbed suture was used to close the peritoneal defect. At 47 days after the operation, he was diagnosed with a small bowel obstruction caused by an elongated tail of the barbed suture. Emergency laparoscopic exploration was performed for removal of the embedded suture and detorsion of the volvulus. The second patient is a 50-year-old man who was admitted with a small bowel perforation one week after TAPP herniorrhaphy. Emergency exploration revealed that the tail of the barbed suture had pierced the small intestine, causing a tiny perforation. After cutting and releasing the redundant tail of the barbed suture, the serosal and muscular defect was closed with 2 absorbable single-knot sutures. Both patients have recovered well. Finally, we searched the PubMed database and reviewed the literature on the effectiveness and safety of barbed suture for TAPP.
Surgeons should understand the characteristics of barbed suture and master the technique of peritoneum closure during TAPP in order to reduce the risk of bowel obstruction and perforation.
腹腔镜经腹腹膜前修补术（TAPP）目前常用于腹股沟疝修补。倒刺缝线可能是一种快速有效的腹膜关闭方法。我们报告两例TAPP术后因倒刺缝线导致小肠梗阻和穿孔的罕见病例。
病例1为一名45岁男性，接受了腹腔镜右侧腹股沟疝修补术。使用倒刺缝线关闭腹膜缺损。术后47天，他被诊断为因倒刺缝线的长尾导致小肠梗阻。进行了急诊腹腔镜探查以取出嵌入的缝线并解除肠扭转。第二例患者是一名50岁男性，在TAPP疝修补术后一周因小肠穿孔入院。急诊探查发现倒刺缝线的尾部刺穿了小肠，造成一个小穿孔。在剪断并松开倒刺缝线的多余尾部后，用2根可吸收单结缝线关闭浆膜和肌肉缺损。两名患者均恢复良好。最后，我们检索了PubMed数据库并复习了关于倒刺缝线用于TAPP的有效性和安全性的文献。
外科医生应了解倒刺缝线的特点，并在TAPP过程中掌握腹膜关闭技术，以降低肠梗阻和穿孔的风险。
