title: 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"?
abstract: BACKGROUND
  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.
  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 5cm 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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany. Electronic address: filser_j@ukw.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Filser
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Reibetanz
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
authors.forename: Katica
authors.initials: K
authors.lastname: Krajinovic
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
authors.forename: Ulrich Andreas
authors.initials: UA
authors.lastname: Dietz
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Seyfried
keywords: Small bowel volvulus; TAPP; Transabdominal perperitoneal hernia repair; V-Loc™ wire