Complete Surgical Decompression for Late Obstruction of the Small Intestine, with Reference to a Method

Baker, Joel W.; Ritter, K. J.

doi:10.1097/00000658-196305000-00010

Cited by 17 publications

(5 citation statements)

References 6 publications

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“…In the mobile portion of the jejunum just distal to the ligament of Treitz or to a gastrojejunal anastomosis, one creates a seromuscular tunnel by inserting a 14-gauge needle within the wall of the bowel through a 3-0 silk purse string suture. The needle is then turned into the lumen of the bowel and [12][13][14][15][16][17][18] inches of a 16-gauge catheter are threaded down the lumen of the jejunum. The needle is withdrawn and the purse string suture tied.…”

Section: Lb Over 5 Monthsmentioning

confidence: 99%

Intrajejunal Feeding: Development and Current Status

Ryan

Page

1984

J Parenter Enteral Nutr

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Techniques of jejunostomy were established in surgical practice by the turn of the century. They were mainly used to administer normal food for the palliation of advanced gastric cancer. Standard postoperative intravenous fluid therapy did not begin in earnest until the late 1930's and did not become routine until the late 1940's because of pyrogens, fear of fluid overload, and commercial nonavailability. For most gastric procedures performed from 1900 until 1940, postoperative treatment consisted of nutrient and saline enemas and subcutaneous infusion of fluid. Jejunal feedings had their greatest use between 1930 and 1950. Gastrectomy was widely applied for cancer and ulcers in dehydrated, malnourished patients. The importance of hypoproteinemia and malnutrition on postoperative morbidity and mortality was established, and the inability of subcutaneous infusions and nutrient enemas to counteract malnutrition and dehydration was recognized. Jejunostomy or nasojejunal tubes were recommended for routine use after gastric operations. During this period, the major advances in jejunal diets and methods of feeding were accomplished. Attention was paid to assuring adequate amounts of nutrients, minerals, and vitamins, and finding diets that were easily tolerated by the jejunum. Important in these developments was the collaboration of surgeons with physiologists, gastroenterologists, pharmacologists, and members of industry. Several factors combined to reduce the use of jejunostomy after 1950. Intravenous therapy became familiar to the surgical profession, widely available, and safe. The number of gastric resections performed has decreased. Earlier referral for operation has resulted in patients with less preoperative debility and malnutrition. By 1970, total parenteral nutrition was available, and fewer jejunostomies were perceived as necessary. During the same interval, however, the increasing incidence of patients with pancreatic, esophageal, and hepatobiliary disease who faced major operations and catabolic postoperative courses presented a new challenge to the surgical community. A resurgence of concern for nutritional support, in part generated by the availability of total parenteral nutrition, prompted a renewed interest in using the gut for feeding the postoperative patient. This renewed interest, an understanding of the techniques of parenteral nutrition, the rediscovery of the gut as an absorptive surface in the postoperative patient, and the ready availability of a variety of defined formula diets have combined to rekindle the enthusiasm of many surgeons for complementary or adjuvant feeding jejunostomy.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Lb Over 5 Monthsmentioning

confidence: 99%

Intrajejunal Feeding: Development and Current Status

Ryan

Page

1984

J Parenter Enteral Nutr

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“…Die yon Baker angeregte Gastrostomie [7,8] erfibrigt sich daher. Bei den 19 Patienten der Gruppe 1 f~llt eine rasehe Erholung der Darmfunktion auf: Die Magensonde mul3 nur Ibis 2 Tage belassen und die perorale Ern~hrung kann bereits am 3. postoperativen Tag begonnen werden.…”

Section: Diskussionunclassified

“…Verschiedene Verfahren sind bekannt, wobei prinzipiell zwisehen extra-und intraluminalen Methoden unterschieden werden kann. Die Erfahrungen mit der Baker-Teehnik waren gut: Kurzer postoperativer Verlauf mit wenig Komplikationen, kleine IleusrezidivTate [8,9]. Erfahrungen mit der Noble-Technik zeigten, dal3 die Operation sehr zeitaufwendig und mit vielen Komplikationen behaftet ist [5].…”

Section: Introductionunclassified

D�nndarmschienung in der operativen Behandlung des Adh�sionsileus

Tondelli

Müller

Enderlin

et al. 1975

Langenbecks Arch Chiv

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As an alternative to the extraluminal methods of Noble and Childs-Phillips, the intraluminal splinting of small bowel with the Baker-Tube offers a new possibility in the operative treatment of ileus secondary to adhesions. We report our experiences in 28 patients, using this procedure. An unselected group with severe adhesions was treated with the Baker-Tube, in the majority of the cases at the time of the emergency operation. The immediate postoperative course as well as the results of follow-up examinations 1/2 to 3 1/2 years after the operation are reported. Our experiences can be summarized as follows: 1. Generalized, extensive adhesions are the best indication for the intraluminal splinting. The Baker-Tube should be used with reserve in cases of early and often complicated relaparotomies, especially in the presence of diffuse peritonitis, because of the danger of bowel perforation at the tip of the Tube. 2. The procedure is less time consuming than Noble's operation and in addition allows immediate decompression of the small bowel while advancing the tube. A careful technique is important to prevent complications:--tight closure of the jejunostomy at the insertion point.--fixation of the jejunal loop to the abdominal wall with non absorbable sutures.--in cases of compromised lumen at the insertion point, an entero-entero-anastomosis between afferent and efferent loop should be done. With these precautions, fistulas, detachment of the jejunostoma and stenosis of the jejunal loop can be prevented. 3. Postoperative bowel function is usually rapidly restored, a distinct advantage when compared to the Noble procedure. 4. The rate of complications in our patients is lower than in a reported comparable group with Noble technique. 5. The recurrence rate is much lower than in a reported comparable group with Noble technique. Intraluminal splinting with the Baker-Tube can be recommended as an effective procedure in the treatment of ileus secondary to adhesions.

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“…In last few decades, the scenario of diagnosis and management of pediatric intestinal obstruction has been changed due to better understanding of pathophysiology, improvement in diagnostic methods, availability of better antibiotics, safer pediatric anesthesia and advanced pre and post operative intensive care. [1] Name & Address of Corresponding Author Dr. Rahul Tanwani Assistant Professor, Department of Surgery, Index medical college, Indore, India.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Obstruction in Pediatric Age Group: A Clinico- Pathological Study

Maheshwari¹,

Tanwani²,

Patel³

et al. 2016

AIMDR

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Background: Intestinal obstruction is one of the commonest surgical emergencies seen in pediatric patients. In last few decades, the scenario of diagnosis and management of pediatric intestinal obstruction has been changed due to better understanding of pathophysiology, improvement in diagnostic methods, availability of better antibiotics, safer pediatric anesthesia and advanced pre and post operative intensive care. Objectives: To study the epidemiology, clinical features and outcome of intestinal obstruction in paediatric patients. Methods: The present prospective study was conducted in department of General Surgery, Index Medical College, Indore in paediatric patients admitted with clinical features and diagnosis of intestinal obstruction between July 2014 to June 2016 (2 years). Results: Majority of cases of intestinal obstruction in our study were in age group of 0-1 years (70.2%), followed by the age group of 1-5 years (20.2%) and more than 5 years (9.6%). Conclusion: Majority of patients (70.2%) were of less than one year age, and male to female ratio was found to be 3.5:1. Congenial causes of intestinal obstruction were more common (61.7%) than the acquired causes. Intussusception (18.1%) was the commonest cause of intestinal obstruction in this series.

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Complete Surgical Decompression for Late Obstruction of the Small Intestine, with Reference to a Method

Cited by 17 publications

References 6 publications

Intrajejunal Feeding: Development and Current Status

Intrajejunal Feeding: Development and Current Status

D�nndarmschienung in der operativen Behandlung des Adh�sionsileus

Intestinal Obstruction in Pediatric Age Group: A Clinico- Pathological Study

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