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Protective fibrin-sealed plication of the small bowel in recurrent laparotomy
S Holland-Cunz1, A V Boelter, K L Waag
1Department of Paediatric Surgery, University Hospital of Mannheim/Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. stefan.holland-cunz@kch.ma.uni-heidelberg.de
Insights
Fibrin-glued plication of the small bowel effectively reduces the risk of recurrent intestinal obstruction in children. This simple, time-saving surgical technique showed no observed side effects in the study.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Biomaterials in surgery
Background:
- Postoperative adhesions following abdominal surgery are a common cause of morbidity in children.
- Recurrent intestinal obstruction due to adhesions necessitates further surgical interventions and impacts patient outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes of fibrin-glued small bowel plication in children who underwent recurrent laparotomies.
- To determine the efficacy of fibrin sealant in preventing postoperative intestinal obstruction.
Main Methods:
- A retrospective analysis of 60 children who underwent fibrin-glued small bowel plication between 1991 and 1999.
- The technique involves positioning small bowel loops side-by-side and securing them with fibrin sealant to create a meander-like formation.
- Patient data and outcomes were assessed through chart reviews, questionnaires, and clinical examinations.
Main Results:
- No intraoperative complications were associated with the fibrin-glued plication procedure.
- 12% of patients (7/60) experienced recurrent ileus or subileus postoperatively.
- 5% of patients (3/60) required early relaparotomy due to complications.
Conclusions:
- Fibrin-glued small bowel plication is a simple and effective method for decreasing the risk of recurrent intestinal obstruction in pediatric patients.
- The procedure is time-saving and demonstrated no adverse side effects related to the fibrin sealant.
- This technique offers a promising solution for managing adhesions after recurrent abdominal surgeries.
Purpose:
Adhesions after recurrent abdominal operations remain extremely common and are sources of severe morbidity. Fibrin-glued plication of the small gut in a meander-like formation is supposed to guarantee a decreased risk of intestinal obstruction postoperatively. This retrospective study analyses the clinical outcome after recurrent laparotomy in children treated with bowel plication by fibrin sealant.
Methods:
The surgical technique of performing the fibrin-glued plication is rather simple and quick: after taking off all adhesions two to four loops of the small gut are positioned so that they lie side by side. Beginning proximal fibrin [Tissucol fibrin sealant (Baxter)] is applied between the loops; approximately 20-30 s are needed to keep the loops in position until the fibrin dries. This manoeuvre is continued until all of the small gut is fixed in one block. The gut is brought back into the abdominal cavity without loosening the loops. This fixed formation by sero-serosal adhesions or mesenterial plications is supposed to guarantee postoperative free passage. The charts of 60 children who had undergone a fibrin plication of the small bowel between 1991 and 1999 were evaluated. Additionally, questionnaires were sent to all patients, and they were invited for an examination.
Results:
Sixty patients (38 boys and 22 girls) received a fibrin sealant plication because of recurrent laparotomies with heavily serosal defects or recurrent ileus because of adhesions. The youngest baby was 10 days. Since 23 patients were premature the oldest patient was 11 years old. There were no intraoperative complications attributed to the method. In the postoperative period 7/60 (12%) patients had a recurrent ileus or subileus, leading in three (5%) patients to an early relaparotomy.
Conclusion:
The fibrin-glued plication of the small bowel decreases the risk of recurrent ileus or subileus considering the high figures in the literature concerning this issue. The time-saving method is very simple and easily feasible. No side effects after the treatment with fibrin glue were observed.