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Ataya K, Patel N, Yang W, Aljaafreh A, Melebari SS. Safety and Efficacy of Barbed Sutures Compared to Non-barbed Sutures in Bariatric Surgery: An Updated Systematic Review and Meta-analysis. Obes Surg 2024:10.1007/s11695-024-07382-3. [PMID: 39078450 DOI: 10.1007/s11695-024-07382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Mastering intracorporeal suturing is challenging in the evolution from conventional to laparoscopic bariatric surgery. Among various techniques competing for superiority in overcoming this hurdle, we focus on exploring the potential of barbed sutures through a meta-analysis that compares outcomes to those of conventional non-barbed sutures in bariatric surgery. MATERIALS AND METHODS We conducted a comprehensive search on PubMed, Scopus, and Embase to identify studies comparing barbed sutures with non-barbed sutures in bariatric surgeries, focusing on outcomes such as operative time, suturing time, postoperative complications, and hospital stay. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. RESULTS Incorporating data from 11 studies involving a total of 27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries, our analysis demonstrates a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p < 0.01; I2 = 99%) associated with the use of barbed sutures. Specifically, in Roux-en-Y gastric bypass, we observed a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p < 0.01; I2 = 93%). Subgroup analyses and leave-one-out analyses consistently supported these findings. Furthermore, we found that the mean body mass index did not significantly predict the mean difference in operative time outcome. No significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction (p > 0.05). CONCLUSION Our study findings address barbed sutures as a potential alternative for laparoscopic intracorporeal suturing in bariatric surgery.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, University of Montreal, Montreal, H3C 3J7, Canada
| | - Neha Patel
- Department of General Surgery, Government Medical College Surat, Surat, 395001, India
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Almoutuz Aljaafreh
- Department of Bariatric Surgery, St Georges University Hospitals NHS Foundation Trust, London, SW17 0QT, England
| | - Samah Sofyan Melebari
- Department of Bariatric Surgery, King Abdullah Medical City, Makkah, 24246, Saudi Arabia
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2
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Pyo DH, Yun SH, Lee WY. A prospective single-arm clinical trial to assess the safety and efficacy of monofilament polydioxanone barbed suture, MONOFIX ®, on abdominal fascial closure. World J Surg 2024; 48:1674-1680. [PMID: 38877993 DOI: 10.1002/wjs.12247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND For abdominal fascial closure, the choice of optimal suture material and appropriate suture technique are of paramount importance to prevent the incidence of incisional hernia. Although barbed sutures are widely used in various surgical fields, their safety and feasibility on abdominal fascial closure which requires the most tensile strength for security have not been established yet. METHODS We conducted a prospective, single-arm, interventional clinical trial to present the postoperative outcomes of using barbed sutures in abdominal fascial closure between April 2021 and August 2021. Patients with colorectal cancer who underwent minimally invasive surgery in elective setting were included. For all participants, monofilament polydioxanone barbed suture, MONOFIX®, was used to secure the abdominal fasica. The primary outcome was the 1-year incidence of incisional hernia assessed by computed tomography. RESULTS A total of 30 patients were included. The median fascial incision length and suture length were 6.5 cm (range, 6-7.5 cm) and 31 cm (range, 27.5-39.0 cm), respectively. The median procedure time of abdominal fascial closure was 4 min (range, 3-9 min). There was no incidence of unexpected event related to suturing including suture cutting, stopper separation from threads, and suture loosening. One case of superficial surgical site infection occurred during postoperative hospital stays. There was no fascial dehiscence, incisional hernia, and adhesive ileus during a median follow-up period of 17.5 months. CONCLUSION Monofilament polydioxanone barbed suture, MONOFIX®, may be used safely and effectively on abdominal fascial closure. CLINICALTRIALS GOV NUMBER NCT05872334.
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Affiliation(s)
- Dae Hee Pyo
- Department of Surgery, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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3
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Reynolds E, Bergeron T, Shapiro K, Abraham N. Bowel Complications Due to Barbed Suture (V-LOCK) Use During Sacrocolpopexy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:461-465. [PMID: 37738015 DOI: 10.1097/spv.0000000000001417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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Pajtak R, Ibraheem C, Mori K. Catastrophic complications of a robot-assisted laparoscopic sacrocolpopexy with a barbed suture: ischaemic bowel. J Surg Case Rep 2024; 2024:rjae145. [PMID: 38495047 PMCID: PMC10941973 DOI: 10.1093/jscr/rjae145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Robot-assisted laparoscopic sacrocolpopexy with barbed sutures has become increasingly utilized due to known benefits of minimally invasive surgery. It is equally as important to recognize the unusual life-threatening complications which may arise in patients presenting with an acute abdomen up to several weeks post-robotic surgery. A 54-year-old woman presented with acute, sudden onset abdominal pain and underwent a diagnostic laparoscopy for suspected small bowel ischemia. The procedure progressed to an open laparotomy where it was found that a V-Loc suture placed during robot-assisted laparoscopic sacrocolpopexy several weeks prior was causing strangulation of the small bowel. Following resection and side-to-side anastomosis the patient spent several days in the intensive care unit and developed a post-operative ileus, however, was eventually discharged home. When evaluating the acute abdomen in the context of recent robotic surgery, ischaemic bowel must be considered as a complication.
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Affiliation(s)
- Renata Pajtak
- Division of General Surgery, The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia
| | - Christian Ibraheem
- Division of General Surgery, The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia
| | - Krinal Mori
- Division of General Surgery, The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia
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Takagi H, Wada N, Morishita S, Ohtani M, Kitta T, Kakizaki H, Kohro D, Shonaka T. Postoperative small intestinal obstruction caused by barbed suture after robot-assisted laparoscopic sacrocolpopexy. IJU Case Rep 2024; 7:105-109. [PMID: 38440710 PMCID: PMC10909132 DOI: 10.1002/iju5.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/29/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction We present a case of small intestinal obstruction due to a barbed suture used for peritoneal closure during robot-assisted laparoscopic sacrocolpopexy. Case presentation A female patient with pelvic organ prolapse underwent robot-assisted laparoscopic sacrocolpopexy uneventfully. Intestinal obstruction developed on postoperative Day 4. Conservative treatment with the ileus tube failed to improve abdominal symptoms. The laparoscopic examination on postoperative Day 14 revealed the barbed suture entangled with the small intestinal mesentery. The tail of the barbed suture was laparoscopically detached from the mesentery without damaging the small intestine. The tail of the barbed suture was trimmed; an antiadhesive material was applied to the peritoneal closure line and the trimmed tail of the barbed suture. Conclusion We recommend the use of conventional absorbable sutures in the peritoneal cavity because of the potential risk of intestinal obstruction caused by the barbed suture.
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Affiliation(s)
- Haruka Takagi
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Naoki Wada
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Shun Morishita
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Miyu Ohtani
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Takeya Kitta
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Daisuke Kohro
- Department of Gastrointestinal SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Tatsuya Shonaka
- Department of Gastrointestinal SurgeryAsahikawa Medical UniversityAsahikawaJapan
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Förster CE, Calabretti I, Gubser L, Schötzau A, Fellmann-Fischer B, Heinzelmann-Schwarz V, Zwimpfer TA. Comparison of different suture techniques for laparoscopic vaginal cuff closure. Sci Rep 2024; 14:4860. [PMID: 38418580 PMCID: PMC10901882 DOI: 10.1038/s41598-024-55586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
Laparoscopic hysterectomy is a commonly performed procedure. However, one high-risk complication is vaginal cuff dehiscence. Currently, there is no standardization regarding thread material or suturing technique for vaginal cuff closure. Therefore, this study aimed to compare extracorporeal and intracorporeal suturing techniques for vaginal cuff closure using a pelvic trainer model. Eighteen experts in laparoscopic surgery performed vaginal cuff closures with interrupted sutures using intracorporeal knotting, extracorporeal knotting and continuous, unidirectional barbed sutures. While using an artificial tissue suturing pad in a pelvic trainer, experts performed vaginal cuff closure using each technique according to block randomization. Task completion time, tension resistance, and the number of errors were recorded. After completing the exercises, participants answered a questionnaire concerning the suturing techniques and their performance. Experts completed suturing more quickly (p < 0.001, p < 0.001, respectively) and with improved tension resistance (p < 0.001, p < 0.001) when using barbed suturing compared to intracorporeal and extracorporeal knotting. Furthermore, the intracorporeal knotting technique was performed faster (p = 0.04) and achieved greater tension resistance (p = 0.023) compared to extracorporeal knotting. The number of laparoscopic surgeries performed per year was positively correlated with vaginal cuff closure duration (p = 0.007). Barbed suturing was a time-saving technique with improved tension resistance for vaginal cuff closure.
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Affiliation(s)
- Christiane E Förster
- Department of Gynecological Oncology, University Hospital Basel, 4056, Basel, Switzerland
| | | | - Laura Gubser
- Medical Faculty, University of Basel, 4056, Basel, Switzerland
| | - Andreas Schötzau
- Department of Gynecological Oncology, University Hospital Basel, 4056, Basel, Switzerland
| | | | | | - Tibor A Zwimpfer
- Department of Gynecological Oncology, University Hospital Basel, 4056, Basel, Switzerland.
- Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
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Wang L, Maejima T, Fukahori S. A Novel Hidden Stitching Method for Preventing Complications in Laparoscopic Hernia Repair. Am Surg 2023; 89:4321-4326. [PMID: 35695170 DOI: 10.1177/00031348221101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Barbed suture provides a rapid and effective method for closure in minimally invasive surgery. However, postoperative complications involving barbed suture have been reported in recent years. The aim of this study is to introduce a novel hidden stitching technique for peritoneal closure in laparoscopic hernia repair. METHOD This study retrospectively analyzed the data of patients with laparoscopic transabdominal preperitoneal patch (TAPP). In the hidden stitch (HS) group, the barbed suture was hidden on the dorsal side of the peritoneum and two stitches were returned in the opposite direction after the suture reached the end point. In the non-hidden stitch (NHS) group, the barbed sutured was exposed in the peritoneal cavity with a tail stump of approximately 10 mm preserved to prevent the peritoneal sutures from loosening. RESULTS Twenty-seven patients in the HS group were compared with 53 in the NHS group. There were no differences in age, body mass index, surgical bleeding, or length of hospital stay between the two groups. The peritoneal defect closure time was slightly longer (3 min) in the HS group, but the overall operation time was not significantly extended. There were 8 cases of postoperative complications (P = .035) including 4 cases of bowel obstruction due to the tail of the barbed thread penetrating the small intestine mesenteric and two cases of seroma. There were no postoperative complications in the HS group. CONCLUSIONS The hidden stitch method is a safe and feasible peritoneal closure technique that may reduce postoperative complications caused by barbed suture in laparoscopic hernia repair.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Siragusa L, Usai V, Pirozzi BM, Dhimolea S, Franceschilli M. Early Gastric Outlet Obstruction Caused by the Free End of Barbed Sutures Following Laparoscopic Gastric Resection with Roux-en-Y Reconstruction. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940661. [PMID: 37807466 PMCID: PMC10578498 DOI: 10.12659/ajcr.940661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/21/2023] [Accepted: 07/28/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Recent developments in surgical suture material include the use of sutures with unidirectional barbs that facilitate laparoscopic suturing thanks to self-anchoring and tension-keeping properties. Complications deriving from the use of barbed sutures have been previously reported. In this report we present the case of a patient with gastric outlet obstruction by the free end of a V-Loc™ barbed suture (Medtronic, Dublin, Ireland) following Roux-en-Y gastric resection. CASE REPORT In February 2023, a 77-year-old man who underwent laparoscopic subtotal gastrectomy for cancer followed by Roux-en-Y reconstruction developed symptoms of gastric outlet obstruction a few days after discharge. The patient was readmitted to the hospital due to vomiting 4 days after being discharged after an uneventful postoperative course. Imaging confirmed the presence of an occlusion at the level of the jejunojejunal anastomosis, with a noticeable change in caliber. During laparoscopy, a loop of bowel was entrapped around the tail of the barbed suture used to close the common enterotomy of jejunojejunal anastomosis. Following laparoscopic division of the anchoring suture, the bowel regained its normal caliber. CONCLUSIONS Although complications from the use of unidirectional barbed surgical sutures are rare, this report highlights bowel obstruction as a recognized postoperative complication. The preferred treatment is laparoscopic division of the suture's tail. To prevent complications related to barbed sutures, it is essential to ensure that all barbs of the suture are properly unfolded.
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9
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Riemma G, De Franciscis P, La Verde M, Ravo M, Fumiento P, Fasulo DD, Della Corte L, Ronsini C, Torella M, Cobellis L. Impact of the hemostatic approach after laparoscopic endometrioma excision on ovarian reserve: Systematic review and network meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2022. [PMID: 36503998 DOI: 10.1002/ijgo.14621] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve. OBJECTIVES To evaluate which hemostatic approach after stripping cystectomy shows less damage on ovarian reserve. SEARCH STRATEGY Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference abstracts, and International Clinical Trials Registry Platform were searched from inception until April 2022. SELECTION CRITERIA Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches. DATA COLLECTION AND ANALYSIS Relevant data were extracted and tabulated. Network meta-analysis based on random-effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3 months after surgery. MAIN RESULTS Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle-stimulating hormone levels (SUCRA, 88.70%). CONCLUSIONS Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher.
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Affiliation(s)
- Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mariangela Ravo
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pietro Fumiento
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Diego Domenico Fasulo
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Cobellis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Limbachiya D, Tiwari R, Kumari R, Aggarwal M. Barbed Suture Causing Acute Small Bowel Obstruction Post Laparoscopic Sacrocolpopexy. CRSLS : MIS CASE REPORTS FROM SLS 2022; 9:JSLS.2022.00058. [PMID: 36452882 PMCID: PMC9682608 DOI: 10.4293/crsls.2022.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction A case report of small bowel obstruction related to barbed suture in a postoperative patient of laparoscopic sacrocolpopexy. Case Description A 61 -year-old female with a body mass index of 27 with vault prolapse underwent laparoscopic sacrocolpopexy. The patient was discharged on postoperative day two. She presented again in the emergency department on the fifth postoperative day with complaints of frequent vomiting episodes with intermittent and colicky pain in the abdomen. Her imaging (computed tomography abdomen/pelvis with oral contrast) suggested distal small bowel mechanical obstruction at midileum with significant free fluid in the peritoneum. Emergency laparoscopic exploration was done. Peroperative V-LocTM 180 suture tail end barbs were found anchored to the mesentery of midileum causing a loop that led to compression and occlusion of distal bowel. The barbed suture tail end was detached from the mesentery and thus relieving the compression. No additional procedure was required for the bowel wall. The excess barbed suture tail end outside the peritoneum was trimmed. The postoperative course was uneventful. Conclusion Bowel complication is an uncommon but serious issue following the use of barbed sutures. It should be used with utmost caution as none of the preventive measures are completely safe. Further studies need to be done for preventive measures.
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Affiliation(s)
- Dipak Limbachiya
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Rajnish Tiwari
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Rashmi Kumari
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Manoj Aggarwal
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
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Stabile G, Foti C, Mordeglia D, De Santo D, Mangino FP, Laganà AS, Ricci G. Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature. J Clin Med 2022; 11:jcm11113226. [PMID: 35683613 PMCID: PMC9181553 DOI: 10.3390/jcm11113226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Correspondence:
| | - Carmelina Foti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Denise Mordeglia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
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12
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Stabile G, Romano F, Topouzova GA, Mangino FP, Di Lorenzo G, Laganà AS, De Manzini N, Ricci G. Spondylodiscitis After Surgery for Pelvic Organ Prolapse: Description of a Rare Complication and Systematic Review of the Literature. Front Surg 2021; 8:741311. [PMID: 34778360 PMCID: PMC8586200 DOI: 10.3389/fsurg.2021.741311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spondylodiscitis can be a rare complication of gynecological surgery, typically of procedures involving the sacrum and the sacrospinous ligament. This report presents a case of spondylodiscitis arising after a laparoscopic sacrocolpopexy with a mesh. We also review the literature finding 52 cases of spondylodiscitis following sacrocolpopexy and (or) rectopexy with or without a mesh. Methods: We performed a comprehensive search from the electronic databases MEDLINE (Pubmed), Scopus, Web of Science, Embase, CINAHL, and Google Scholar from 1990 to February 2021 in order to identify case reports or case series reporting on spondylodiscitis after rectopexy or sacrocolpopexy. Results: We identified 52 total postoperative spondylodiscitis. We examined the mean age of patients, the surgical history, the time from initial surgery to spondylodiscitis, the presenting symptoms, the diagnostic tools, the medical and surgical treatment, the type of mesh used, the surgical access, and the possible causes of spondylodiscitis. Conclusions: Diagnosis of spondylodiscitis may be challenging. From our review emerges that recurrent pelvic pain and lumbosciatalgia may be signals of lumbar spondylodiscitis. Magnetic resonance is the gold standard examination for spondylodiscitis. Surgical practice needs to be improved further in order to establish the best procedure to minimize the incidence of this complication. Awareness of symptoms, timely diagnosis, and treatment are fundamental to prevent irreversible complications.
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Affiliation(s)
- Guglielmo Stabile
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Federico Romano
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Ghergana A Topouzova
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Paolo Mangino
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Giovanni Di Lorenzo
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Nicolò De Manzini
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy.,University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Wang L, Maejima T, Fukahori S, Nishihara S, Yoshikawa D, Kono T. Bowel obstruction and perforation secondary to barbed suture after minimally invasive inguinal hernia repair: report of two cases and literature review. Surg Case Rep 2021; 7:161. [PMID: 34255201 PMCID: PMC8276904 DOI: 10.1186/s40792-021-01249-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic transabdominal preperitoneal patch (TAPP) is now commonly used in the repair of inguinal hernia. Barbed suture can be a fast and effective method of peritoneal closure. We report two rare cases of small bowel obstruction and perforation caused by barbed suture after TAPP. CASES Patient 1 is a 45-year-old man who underwent laparoscopic repair of a right inguinal hernia. Barbed suture was used to close the peritoneal defect. At 47 days after the operation, he was diagnosed with a small bowel obstruction caused by an elongated tail of the barbed suture. Emergency laparoscopic exploration was performed for removal of the embedded suture and detorsion of the volvulus. The second patient is a 50-year-old man who was admitted with a small bowel perforation one week after TAPP herniorrhaphy. Emergency exploration revealed that the tail of the barbed suture had pierced the small intestine, causing a tiny perforation. After cutting and releasing the redundant tail of the barbed suture, the serosal and muscular defect was closed with 2 absorbable single-knot sutures. Both patients have recovered well. Finally, we searched the PubMed database and reviewed the literature on the effectiveness and safety of barbed suture for TAPP. CONCLUSIONS Surgeons should understand the characteristics of barbed suture and master the technique of peritoneum closure during TAPP in order to reduce the risk of bowel obstruction and perforation.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Shoji Nishihara
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Toru Kono
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
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