Improved Childs-Phillips Intestinal Plication

October 7, 2024 | By admin | Filed in: Document.

A modified Childs-Phillips intestinal plication technique is described. The addition of a portion of Teflon felt at the site of the curve of the thread protects the vessels of the mesentery from direct contact with the suture and erosion.

The Childs-Phillips plication operation was performed in forty-two patients, as treatment for recurrent small bowel obstruction in nineteen and as prophylaxis against future intestinal obstruction in twenty-three. Intestinal obstruction occurred later in only one patient. Eight of ten patients with acute peritonitis died in the postoperative period. Consequently, the operation is not recommended in the presence of generalized acute peritonitis.

Only one patient of the thirty-one surviving has experienced crampy abdominal pain. Prudent use of the operation is recommended for both therapeutic and prophylactic purposes.

It has been quite a long time since Noble wrote: “Accepting the proven fact that adhesions can not be prevented we probably can obtain success by putting to use that which we know will occur in an arbitrary manner of the surgeon’s choice.”

Due to certain disadvantages of the Noble plication, namely formation of fistulas and abscesses between the adherent loops, as well as the long du- ration of the operation, Childs and Phillips de- Ftgure 1. lntestlnal loops are placed in a row. scribed in 1960 their knitting needleplication technique which minimizes the length of operation and does not interfere with the wall of the intestine.

Clinical Material During the last 19years we have used the Childs-Phillips plication method in 112patients with good results. We had, however, two cases of delayed hemorrhage. One was due to formation of a mesenteric hematoma and a prolonged intestinal ileus 15days after the operation and the other was due to intraabdominal blood collection. The hemorrhage was due to erosion of the mesenteric vessels at the site of the curve of the thread, as was proved at reoperation.


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