when peritoneal cavity is opened , in whatever type of surgery , bowel obstruction may develop due to bands or adhesions .
the release of such adhesions results in serosal injury to the bowel and is a potential threat for re - adhesion and obstruction .
use of intraluminal tube stenting of the bowel after release of adhesions precludes recurrent small bowel obstructions .
over a period of 14 years , six children needed intraluminal stenting of the bowel to prevent recurrent obstruction .
four of these children needed two surgeries in the immediate postoperative period . in two other children who developed adhesive obstruction in the postoperative period ,
release of dense adhesions resulted in raw areas in peritoneum and the bowel , and stenting of the bowel was done to prevent re - adhesion .
of the six children , three were following surgery for hirschsprung 's disease , while the other three were due to intestinal duplication , meckel 's diverticulum and meconium ileus . in the absence of the availability of pediatric size baker 's type of tube which has a bulb distally for easy passage across the bowel , we used two 10f ryle 's tubes of 100 cm each , stitched together and guided through a jejunostomy in two children .
the tubes were stitched with 2/0 silk twice and tested to see that it does not break before passing across the bowel .
the tubes were guided upward through the base of the appendix after appendicectomy to the jejunum . in children with gross distension of bowel
, a 10f ryle 's tube with side holes was inserted through a purse string in upper jejunum and the bowel was decompressed by suction , and then the second tube was stitched to the first and guided toward the cecum .
similar procedure was done when the tubes were guided from the base of the appendix after appendicectomy .
the stenting through the base of the appendix after appendicectomy and subsequent fixation of the tube through right iliac fossa results in natural lie of the bowel .
the four children in whom the above method was done went home without any problem .
the bowel is returned in anatomical way ; the adhesions which are certain to recur are thereby fixed with the bowel in a non - obstructing position .
the child can be fed orally after 34 days when the bowel function returns to normal .
stenting through jejunostomy was preferred when there was gross distension of proximal bowel for easy decompression and the base of the appendix in the rest [ figure 1 ] .
two 100 cm ryle 's tubes joined together and passed from the base of appendix to jejunum
postoperative intraperitoneal adhesions , or bands , resulting from any type of abdominal surgery are the main cause of adhesive postoperative small bowel obstructions , which represent a lifelong issue . after successful relief of obstruction in dense and extensive adhesions
, there is no proven method to prevent formation of further adhesions postoperatively , and a small number of patients are plagued by recurrent obstruction . the need for repeated laparotomy in such patients can pose great technical difficulties for the surgeon .
various methods of prevention of recurrence of adhesive obstructions were tried in adult patients earlier .
plication of the small intestine is often performed in situations suggesting an increased risk of subsequent adhesive obstruction .
this can be accomplished by the external suture methods of noble and modified technique of transmesenteric plication described by childs and phillips .
the major objections to noble 's plication are the duration of the operation and the incidence of postoperative complications .
hyaluronate carboxymethylcellulose preparations have been shown to reduce the extent of adhesions in pediatric patients .
however , in adult patients , several other studies have shown that the use of hyaluronate carboxymethylcellulose agents is associated with a significantly higher incidence of intra - abdominal abscesses and anastomotic leaks .
again , accepting that adhesions will form , intestinal intubation relies on the intrinsic stiffness of the intraluminal tube to permit adhesion formation in a favorable position and to avoid kinking of the bowel whilst adhesions form .
intraluminal stenting of the small bowel after adhesiolysis was originally described by white in 1956 as a possible way to maintain small bowel patency while fresh adhesions form , thereby reducing the risk of subsequent adhesional obstruction .
it was popularized by baker who introduced a long intestinal tube with a foley 's type of bulb distally to facilitate smooth introduction of the tube through jejunostomy .
he emphasised on the need to decompress the distended bowel thoroughly at the time of surgical release of the obstructing adhesion .
complications associated with the jejunal route of stent insertion are infection or prolonged drainage from the jejunostomy site following tube removal , or obstruction at the jejunostomy site and intussusception.[810 ] of the six cases who had intestinal tubing , four children had recurrent adhesive obstruction in the immediate postoperative period . in two children ,
the adhesions were so dense in the first instance and the intestinal stenting was done to prevent further small bowel obstruction
. technically it would be easy to pass the tube across the bowel if there is a foley type of bulb in the tube , and in its absence , ryle 's tube was used in our cases . in the above series ,
there had been no complication at the tube site or in its removal though there is a report that the tube got kinked and there was difficulty in its extraction .
the spillover of the intestinal contents , with its attendant complication of intra - abdominal abscess or wound infection in grossly distended bowel is prevented during jejunostomy or the retrograde passage of tube by passing initially a 10f ryle 's tube with multiple holes and the bowel is decompressed by suction and the second tube attached to it later .
baker returned the bowel with the tube in situ in an orderly manner simulating a plication and wrote that he has only incomplete evidence in some cases that the orderly intestinal pattern is permanently maintained .
we returned the bowel into abdomen in the anatomical way as the return of bowel in the plicated manner in small children was technically difficult .
intestinal intubation in the treatment of patients with recurrent adhesive small bowel obstruction has been documented in adult patients .
the present study , though with a small number of patients , shows its utility in preventing recurrent small bowel obstruction where initial surgery has produced adhesive obstruction .
it is unlikely to be of use in the treatment of localized adhesions or situations where formation of generalized adhesions is uncommon .
 aim : six children with adhesive obstruction in the postoperative period were treated with stenting the small bowel with long intestinal tube.materials and methods : in two children the stenting was done through jejunostomy , and in the other four through the base of appendix.results:during a follow - up period of 2 - 14 years , there had been no recurrence.conclusions:use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONCLUSIONS