K Meissner1. 1. Department of Surgery, District General Hospital, Tamsweg, Austria.
Abstract
BACKGROUND: Established indications (obstructing extensive fibrous adhesions) and contraindications (solitary band- and short segment midgut adhesive obstruction, purulence) of intestinal tube splinting have emerged from clinical practice. The benefit of tube splinting for early postoperative small bowel obstruction (SBO), however, is still a matter of debate. METHODS:From Jan 1980 until Dec. 1989, all patients undergoing relaparotomy for uncomplicated early postoperative SBO were randomized for enterolysis, gut decompression and repair (group A, 28 patients) or the same procedure plus tube splinting (group B, 28 patients). The patients were comparable with respect to gender, age and type of preceding operations; they were followed for 5-14 years or until death. RESULTS: In the early postoperative period, 3 incidences of reobstruction and 8 of other complications were observed in group A vs. 0 and 2, respectively, in group B. No patient died. During follow-up, one patient suffered late SBO, 2 patients recurrent partial SBO and one patient died of bowel perforation in group A vs two incidences of late SBO in group B. CONCLUSIONS:Intestinal splinting performed for early postoperative SBO rendered a significant reduction of early postoperative complications; the protective efficacy against early reobstruction was clinically apparent but reached borderline significance only. In respect to late intestinal complications, splinting was not superior to simple enterolysis. Early and late complications taken together and intestinal complications considered separately were significantly more frequent in patients without splinting.
RCT Entities:
BACKGROUND: Established indications (obstructing extensive fibrous adhesions) and contraindications (solitary band- and short segment midgut adhesive obstruction, purulence) of intestinal tube splinting have emerged from clinical practice. The benefit of tube splinting for early postoperative small bowel obstruction (SBO), however, is still a matter of debate. METHODS: From Jan 1980 until Dec. 1989, all patients undergoing relaparotomy for uncomplicated early postoperative SBO were randomized for enterolysis, gut decompression and repair (group A, 28 patients) or the same procedure plus tube splinting (group B, 28 patients). The patients were comparable with respect to gender, age and type of preceding operations; they were followed for 5-14 years or until death. RESULTS: In the early postoperative period, 3 incidences of reobstruction and 8 of other complications were observed in group A vs. 0 and 2, respectively, in group B. No patient died. During follow-up, one patient suffered late SBO, 2 patients recurrent partial SBO and one patient died of bowel perforation in group A vs two incidences of late SBO in group B. CONCLUSIONS: Intestinal splinting performed for early postoperative SBO rendered a significant reduction of early postoperative complications; the protective efficacy against early reobstruction was clinically apparent but reached borderline significance only. In respect to late intestinal complications, splinting was not superior to simple enterolysis. Early and late complications taken together and intestinal complications considered separately were significantly more frequent in patients without splinting.