INTESTINAL SPLINTING FOR UNCOMPLICATED EARLY POSTOPERATIVE SMALL-BOWEL OBSTRUCTION - IS IT WORTHWHILE

Background: Established indications (obstructing extensive fibrous adh esions) and contraindications (solitary band- and short segment midgut adhesive a obstruction, purulence) of intestinal tube splinting have emerged from clinical practice. The benefit of tube splinting for earl y postoperative-small bowel obstruction (SBO), however, is still a mat ter of debate. Methods: From Jan. 1980 until Dec. 1989, all patients u ndergoing 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 patie nts). The patients were comparable with respect to gender, age and typ e of preceding operations; they were followed for 5-14 years or until death. Results: In the early postoperative period, 3 incidences of reo bstruction and 8 of other complications were observed in group A vs. 0 and 2, respectively, in group B. No patient died. During follow-up, o ne patient suffered Late SBO, 2 patients recurrent partial SBO and one patient died of bowel perforation in group A vs two incidences of lat e SBO in group B. Conclusions: Intestinal splinting performed for earl y postoperative SBO rendered a significant reduction. of early postope rative complications; the protective efficacy against early reobstruct ion was clinically apparent but reached borderline significance only. In respect to Late intestinal complications, splinting was not superio r to simple enterolysis. Early and late complications taken together a nd intestinal complications considered separately were significantly m ore frequently in patients without splinting.