Protective fibrin-sealed plication of the small bowel in recurrent laparotomy.
OBJECTIVE
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.


CONCLUSIONS
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.
Holland-Cunz
S
S
Department of Paediatric Surgery, University Hospital of Mannheim/Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. stefan.holland-cunz@kch.ma.uni-heidelberg.de
Boelter
A V
AV
Waag
K L
KL
D002648:Child; D002675:Child, Preschool; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000517:prevention & control* / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000517:prevention & control* / Q000601:surgery; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive