Abstract
BackgroundSmall bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO.Methods All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well.ResultsNine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery.ConclusionsThis study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.
Highlights
Small bowel obstruction (SBO) is common and usually requires surgical intervention
Demographic and clinical features Between 2010 and 2020, a total of 20 patients that received intestinal plications were enrolled into this study (Additional file 1: Table S1)
The complication rate of external plication reached as high as 54.5 %, including intra-abdominal bleeding, anastomosis leakage and surgical site infection, which was associated with high risk of reoperation and even death
Summary
Small bowel obstruction (SBO) is common and usually requires surgical intervention. Small bowel obstruction (SBO) is a common gastrointestinal disease. Conservative management such as nasogastric decompression plus somatostatin could be effective for most cases, surgical intervention is still critical in certain scenarios especially for ischemic, strangulated or refractory obstructions. Intestinal plication is a traditional surgical technique that is suggested in the management of chronic, idiopathic or high risk of recurrent SBO. Intestinal plication carries considerable damages to the digestive and other systems, and leaves rare chance of re-laparotomy. It is considered as the last and prudent strategy for SBO [1]
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