title: Small bowel obstruction due to laparoscopic barbed sutures: an unknown complication?
abstract: BACKGROUND
  In recent years there has been an increasing uptake in the use of barbed sutures, particularly in minimally invasive and laparoscopic procedures where they may reduce operating time and improve surgical efficiency. However, little is known about the adverse events associated with these new materials and concerns have arisen regarding their safety in certain procedures.
  
  
  METHODS
  We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database). We reveal up to 15 cases of small bowel obstruction (SBO) complicating laparoscopic pelvic surgery that have been reported to date adding two cases of SBO in our own practice following the use of barbed sutures in laparoscopic operations, both requiring surgical re-intervention in the early post-operative period.
  
  
  RESULTS
  Fifteen similar cases of small bowel obstruction were identified, all of which occurred in patients undergoing surgery below the transverse colon . Surgical re-intervention was required in all cases although 60% of these were performed laparoscopically.
  
  
  CONCLUSIONS
  These cases highlight that although barbed sutures provide an attractive means to allow easier and faster laparoscopic suturing, they should be used carefully in inframesocolic surgery and the suture end cut and buried to avoid inadvertent attachment to the small bowel or its mesentery. Barbed suture entanglement should be considered as an uncommon yet potentially serious differential cause for SBO presenting in the early period after laparoscopic surgery where a barbed suture has been used.
authors.affiliation: Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, España.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Segura-Sampedro
authors.affiliation: North West London Hospitals NHS Trust. London, UK.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: North West London Hospitals NHS Trust. London, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Navarro-Sánchez
authors.affiliation: St. Mark's Hospital. Harrow, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: Jenkins
authors.affiliation: Hospital Universitario Virgen del Rocío. Sevilla.
authors.forename: Salvador
authors.initials: S
authors.lastname: Morales-Conde
authors.affiliation: North West London Hospitals NHS Trust. London, UK.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martínez-Isla
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D007582:Jejunostomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation*; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects*