D�nndarmschienung in der operativen Behandlung des Adh�sionsileus

Abstract

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.

Adhesive Small Bowel Obstruction: A Review

“…A long stiff tube is inserted through jejunostomy or through the nasogastric route up to the entry into the large bowel, which acts as an intraluminal splint. 50 Most of the proposed surgical methods are rarely performed these days and are only of historical importance.…”