Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review

Introduction: An high level of surgical ability is required to perform endoscopic knotting. Barbed suture helps avoiding this procedure, thus reducing intraoperative time and providing a minor blood loss and hospitalization. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms. Case presentation: We report two more cases which occurred in our institute in 2020 and review those which have been reported in literature by searching on Pubmed, Scopus and Embase. We used the search terms: "Barbed", "Suture", "Bowel" and "Obstruction". We examined in literature the surgical procedures, the type of complications, the time to onset of the complications and the type of barbed suture. Discussion: Twenty-two cases in total are reported in literature from 2011 to 2020, and bowel complications were largely subsequent to interventions as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered: shortening thread tails, and using antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be an useful suggestions. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damages