An undesired, least expected complication in a routinely followed surgical technique: TAPP for Inguinal hernia: A review article with literature

Abstract

Background:

In the era of minimally access surgery, laparoscopic transabdominal hernia repair (TAPP) has become a standard procedure owing to its benefits as a minimally invasive procedure with less postoperative discomfort and a shorter hospital stay. But benefits accompany a handful complications, although far from many, are gruesome for the surgeon. Here we look at such an appalling complication.

Introduction:

In a TAPP approach to groin hernias, after the placement of a mesh, there are several approaches to close the peritoneum. To prevent mesh exposure to the viscera and the possibility of adhesions and bowel entrapment into peritoneal defects, complete closure is advised in all cases. A rare complication of V-LOC^™ associated bowel obstruction due to a loose long free end is studied and compared with the available literature.

Aim:

To study and review cases of TAPP that have been complicated into post-operative obstruction, secondary to use of barbed sutures, and compare our case that fated the same.

Review Results:

Even after a meticulous closure of the peritoneum following mesh placement in a TAPP, a long cut barbed suture thread hanging into the peritoneum can be a potential cause of or a focus of obstruction. In one of the cases that we studied, it not only resulted in obstruction, but also, lead to perforation of gut viscera [1].

Conclusion:

To lower the risk of intestinal obstruction and perforation during TAPP, surgeons should be well aware about the properties of barbed suture and be proficient at closure of the peritoneum. The free end of the barbed suture that was present in the peritoneal cavity may encourage formation of adhesions, which could lead to bowel obstruction. 

Clinical Significance:

In order to prevent more severe complications, surgeons utilising the barbed suture should be aware of this possible complication whilst operating.