Background

Our patient is a 43-year-old female who came to our attention following a successful laparoscopic sleeve gastrectomy, achieving notable weight loss from an initial preoperative weight of 309 lbs (BMI 47) to a postoperative low of 204 lbs (BMI 31). Eight years following the index surgery, she presented with persistent gastroesophageal reflux and some weight regain (252 lbs, BMI 38). Subsequently, a robot-assisted laparoscopic Roux-en-Y gastric bypass was performed.Despite a generally smooth recovery, the patient experienced abdominal pain, nausea, and vomiting on postoperative day 5. Imaging revealed a partial small bowel obstruction at the level of the jejunojejunostomy. A diagnostic laparoscopy identified an obstruction of the distal Roux limb due to an adhesion to a barbed suture tail at the jejunojejunostomy mesenteric defect. The adhesion was successfully released, the suture tail was cut, and no further interventions were necessary. Post-operatively, she did well without complications, progressing in the advancement of her diet per our institution's protocol. This case demonstrates the potential risks associated with the use of barbed sutures. Despite the absence of an official tail length recommendation from the manufacturer, several documented cases in the literature highlight the occurrence of small bowel obstructions attributed to barbed suture tails. This case, along with others, underscores the importance of minimizing barbed suture tail length in gastrointestinal and bariatric surgery to mitigate the risk of such obstructions.