TRANSMESENTERIC SMALL BOWEL PLICATION OR INTRALUMINAL TUBE STENTING - INDICATIONS AND CONTRAINDICATIONS

Controversy exists as to the efficacy of transmesenteric intestinal plication or long tube stenting of the small bowel in the treatment of severe intestinal adhesions and in late small bowel obstruction. We reviewed our experience with these procedures over a 12 year period with complete follow-up data on 92 per cent of the patients. There were 28 modified Childs-Phillips plications and 37 intraluminal tube decompressions and stenting. For comparison we reviewed 107 cases of small bowel obstruction treated by simple lysis of adhesions. Three deaths and one small bowel fistula were associated with the modified Childs-Phillips procedure; none was directly related to the plication. Three patients required reoperation within the 1st postoperative week for technical reasons. No late operations for recurrent small bowel obstruction were required. One death and one reoperation for bowel obstruction were associated with but not directly related to the Baker tube stenting. Four deaths were associated with simple lysis. Seven patients required reoperation for late recurrent small bowel obstruction. Modified Childs-Phillips transmesenteric plication using nonabsorbable sutures is recommended in cases of severe visceral and parietal peritoneal damage but not in cases of distention and severe ileus of the small bowel or acute generalized peritonitis. Baker tube jejunostomy with decompression and splinting of the small bowel is recommended with massive distention and ileus of the small bowel. Peritonitis is not a contraindication. In our experience fewer short-term complications have occurred after long tube decompression and stenting than after modified Childs-Phillips plication. Measures to avoid these complications are presented. With proper indications, modified Childs-Phillips plication and intraluminal tube stenting are safe and efficient in preventing reobstruction. © 1979.