Effectiveness of Intestinal Tube Splinting: A Prospective Observational Study

Abstract

Background/Aims: To assess the effectiveness of intestinal tube splinting. Patients and Methods: The clinical, operative and outcome data of 186 patients undergoing 200 intestinal splinting procedures from 1973 until 1996 were accumulated in a prospective database. Endpoints were perioperative morbidity, mortality and the incidence of subsequent small bowel obstruction (SBO). The latest follow-up performed in 1998 updated the outcome of 197 procedures after 1–25 (median 7) years. Results: In the early postoperative period, the overall incidence of complications was 9%, procedural complications 2%, and repeat surgery 3%. Three patients died during the index hospitalization. No patient suffered early SBO. Between 1 and 13 years after splinting, 6 complete SBOs (3%) necessitated reoperation and 5 incomplete SBOs (2.5%) were managed conservatively. After splinting for late SBO, freedom from complete SBO was 0.989 and of incomplete SBO 0.906, after splinting for early SBO 0.872 and 0.972, respectively, and for segmental peritonitic SBO freedom from complete SBO 0.8. No obstruction followed prophylactic splinting. Conclusions: Splinting was a reasonably safe procedure with comparatively low morbidity and mortality. The procedure prevented early SBO in all indicatory subgroups, reduced the rate of late recurrent SBO in patients treated for late adhesive SBO as compared with historical outcome data of simple enterolysis and prevented late SBO when performed prophylactically.

Adhäsions-Spätileus – differenzierte Operationsverfahren für differente Adhäsionsmuster: Eine Beobachtungsstudie

“…Data on recurrence rates are comparably scarce and based on a case-mix without stratification by adhesion patterns. Furthermore, it appears noteworthy that the rare recurrences of SBO following ileal adhesiolysis (type 3a) with splinting are predominantly caused by newly formed bands situated orally to post-enterolysis areas [17]. Our overall recurrence rate of 1.9% after a median follow-up of 113 months also compares favorably.…”

Small Bowel Obstruction following Extended Right Hemicolectomy and Subtotal Colectomy: Assessing the Benefit of Prophylactic Tube Splinting / with Invited Commentary

“…Intestinal tube splinting – a proven method eliminating early and selectively reducing late postoperative adhesive SBO [1]– was assessed in this subset of patients. After extended right hemicolectomy and subtotal colectomy, splinting is expeditiously feasible without the need to perform a tube entrance or exit stoma.…”

“…The analysis of reports referring to the latency period until late or recurrent late postoperative SBO surfaces shows that 50% occur within 4 years, 80% within 10 years and the rest during an indefinite period of time thereafter [1, 7, 12, 13, 14]. As 93% of the study group and only 39% of the controls were followed over 4 years, a preliminary assessment of freedom from late SBO may be justified for the study group, whereas the follow-up is too short for controls.…”

“…Intestinal tube splinting – proven to reduce the incidence of subsequent SBO in a general surgical patient population undergoing extensive enterolysis [1]– has also been proposed as a prophylaxis against SBO after colectomy even in the absence of adhesions at the time of colon surgery [2]. This study investigates the pertinent effectiveness of prophylactic tube splinting in patients undergoing extended right hemicolectomy with ileodescendostomy and subtotal colectomy with ileorectostomy, respectively.…”

Ebbott - Miller tube: intubate or not?

“…Дуоденогастральный и желудочно-пищеводный рефлюксы, развитие которых характерно при дренированной тонкой кишке, способствуют развитию эрозивно-язвенного гастродуоденита и эзофагита. Помимо этого, переполнение желудка кишечным содержимым, особенно при смещении отверстий зонда, существенно увеличивает риск инфицирования трахеобронхиального дерева и приводит к увеличению частоты лёгочных осложнений [20]. Именно поэтому необходимо дополнительно устанавливать назогастральный зонд, что наряду с зондом Эбботта -Миллера в носоглотке усугубляет дискомфорт пациента и еще больше затрудняет носовое дыхание [9].…”