Surgical techniques for prevention of recurrence after total enterolysis in encapsulating peritoneal sclerosis

We performed total enterolysis in 130 patients with encapsulating peritoneal sclerosis (EPS) between 1993 and 2007. The postoperative survival rate was 93.1%. However, 33 of the patients (25.4%) required additional surgery for recurrent bowel obstruction. To prevent recurrent bowel obstruction, we investigated various techniques following total enterolysis. In 7 patients, we employed the splinting method, in which the intestinal tract is fixed for 1 week after surgery by the insertion of a long intestinal tube. In 3 of the patients, recurrence was detected within 6 months after surgery. We therefore ceased using splinting. From April 2007, we performed the Noble plication procedure, in which intestine-to-intestine suturing is performed to prevent recurrent bowel obstruction, in 17 patients. None of those patients experienced a recurrence during 8 months of follow-up. In 7 patients showing marked calcification or repeated recurrence, we performed anastomosis of the superior jejunum and transverse colon after adhesiotomy. In 5 patients, excluding 2 with recurrence, improvement was achieved. Total enterolysis for EPS relieved bowel obstruction in most patients. However, after surgery, bowel obstruction recurred in some cases. Thus, strategies to reduce recurrence should be established. Currently, we use total enterolysis and Noble plication as our standard techniques. Further basic and clinical studies regarding EPS prevention and treatment should be conducted.