Stitchless plication for recurring obstruction of the small owel

Abstract

The stitchless tube stent method of orderly intestinal plication is presented as a method to prevent recurring intestinal obstruction. It has several significant advantages over previously proposed methods such as the Noble intestinal suture method or the Child-Phillips transmesenteric suture method. It eliminates the time-consuming use of sutures, avoids the hazard of fistulas, and controls complicating postoperative ileus. It is applicable in acute total obstruction as well as in chronic, partial, or recurring obstruction. In acute obstruction it serves a vital role by decompressing distention. It protects any anastomotic suture lines or weak areas in the wall of the bowel and protects against prolonged postoperative ileus. By continued prevention of intestinal distention it promotes early return of adequate blood perfusion in the wall of the bowel and thereby the restoration of peristalsis and the normal balance between the secretory and absorptive function of the intestinal mucosa. Both morbidity and mortality are reduced and the convalescent period shortened. Our initial fear of trauma to the bowel in the process of stripping has not proved a reality. Likewise, experience has justified the apparent heretical departure from the conservative principles of Ochsner in employing this method, in combination with peritoneal lavage, to treat advanced cases of purulent and bile peritonitis when complicated by obstructive distention.