A 37 y.o. woman s/p robotic assisted myomectomy six weeks pta, presents with 1 day of abd pain, nausea and vomiting

Her myomectomy was completed with a V-lock suture. What complications could occur?

Our patient had a bowel obstruction caused by a V-loc suture which migrated from  the myomectomy site to the small bowel . The V-loc takes 90-110 days to dissolve .

The V-loc suture was  introduced to eliminate the need to tie knots during laparoscopic surgery however complications can occur.  Early in its use the reason for small bowel obstruction was felt to be  a long tail of suture material left after closure so it is recommended the end of the suture be short and fixed to underlying tissue routinely. 

In general laparoscopic surgery causes fewer adhesions and wound infections than open surgery and adhesions are the major cause of early SBO(<6 weeks) after surgery. It is felt that beyond the two week mark, adhesions develop into dense, hypervascular masses causing an increased risk of bowel injury with reoperation.

Port hernias can be found to cause bowel obstruction after laparoscopic surgery

Our patient had ischemia of the small bowel and underwent an ileocecectomy.  The axis of the twisted bowel was found to be where the barbed suture touched the viscera.  She recovered unevenfully.

FUN FACT

SBO post op must be distinguished from post –op ileus since the bowel secretes an opiod compound during surgery.

Jang S, Jung Y , Choi S, Ha T. Postoperative mechanical small bowel obstruction induced by V-Loc barbed absorbable suture after laparoscopic distal gastrectomy. Ann Surg Treat Res. 2017 April 27.

Sakata S, Kabir S, Petersen D, Doudle M, et al. Are we burying our heads in the sand? Preventing small bowel obstruction from the V-loc suture in laparoscopic ventral rectopexy. Colorectal Dis.  2015;17:0183

Goussous N, Kemp K, Bannon M, et al. Early postoperative small bowel obstruction: open vs laparoscopic. 2015 Am J surg  Feb;209(2):385-390.