Ann Surg Treat Res.  2017 Sep;93(3):137-142. 10.4174/astr.2017.93.3.137.

A novel and simple method using a transanal intestinal long tube for protecting intestinal anastomosis and decompressing the small bowel

• Nam SH

• KMID: 2398960
• DOI: http://doi.org/10.4174/astr.2017.93.3.137

Abstract

PURPOSE
I introduce the use of transanal intestinal long tube (TILT) using nasogastric tube. TILT passes from anus to the anastomosis, helping to decompress a dilated bowel loop.
METHODS
TILT procedure was limited to those patients predicting a severe luminal size discrepancy after intestinal anastomosis, and who had postoperative prolonged ileus. We retrospectively reviewed the medical records of 10 infants (7 male an 3 female patients) who were treated using the TILT procedure between 2012 and 2016.
RESULTS
Median gestational age was 27⁺⁵ weeks and birth weight was 940 g. The first operation was done at a median of 4.5 days after birth due to necrotizing enterocolitis perforation (4 cases), isolated intestinal perforation (3 cases), meconium related ileus (1 case), congenital ileal volvulus (1 case), and ileal atresia (1 case). Nine cases of ileostomy closure were planned at a median of 130.5 days with a body weight of 3,060 g. For the ileal atresia case, TILT procedure without additional small bowel resection was performed to treat postoperative prolonged ileus. Nine out of ten were well functioned and defecation via anus was observed in a median of 4.5 days. Milk feeding began at a median of 6 days and the long intestinal tube was removed in a median of 14.5 days.
CONCLUSION
I suggested that TILT procedure could be a noninvasive operative option, predicting of size mismatched anastomosis causing prolonged ileus. Passive drainage of proximal intestinal contents might be helpful for decompress endoluminal pressure during the time of anastomosis healing with bowel movement recovery.

Keyword

Intestinal obstruction; Decompression; Surgical anastomosis

MeSH Terms

Anal Canal
Anastomosis, Surgical
Birth Weight
Body Weight
Decompression
Defecation
Drainage
Enterocolitis, Necrotizing
Female
Gastrointestinal Contents
Gestational Age
Humans
Ileostomy
Ileus
Infant
Intestinal Obstruction
Intestinal Perforation
Intestinal Volvulus
Male
Meconium
Medical Records
Methods*
Milk
Parturition
Phenobarbital
Retrospective Studies
Phenobarbital

Figure

• 

  Fig. 1 (A) At 10 days postoperation, gradual aggravation and distension of the abdominal cavity became pronounced due to lack of stool passage. (B) At 5 days post the second operation, it did not show an improvement of bowel distension.

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  Fig. 2 (A) We made an end to end anastomosis with an interrupt suture; starting with the posterior wall of the anastomosis. (B) The tube was inserted via the anus, and passed through the entire colon to the proximal side of the anastomosis. (C) After the intestinal tube passed over the anastomosis, the anterior wall of the intestine was closed with an interrupt suture.

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  Fig. 3 The infantogram post this transanal intestinal long tube procedure is shown above. (A) Transanal intestinal long tube (TILT) was well located in the small bowel. (B) Small bowel was well decompressed via TILT after 5 days.

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