From Big Medical Encyclopedia

NOBLYA OPERATION (T. V. of Noble, sovr. amer. surgeon; synonym: plication of small intestinum, enteroplikation) — an operational method of connection of loops of a small bowel for the purpose of the prevention of commissural impassability of intestines. Operation is developed and implemented in a wedge, to the practician in 1937 Noblem, to-ry according to various indications made St. 1000 plications of small intestinum. In the 50th surgeons began to apply a plication of small intestinum worldwide. The first operation of a plication of small intestinum is manufactured in the USSR by K. S. Simonyan (1958).

H. to the lake it is shown at a recurrence of commissural intestinal impassability, edges can arise after surgical interventions concerning various diseases or injuries of abdominal organs.

Though Nobl, Seabrook, Wilson (D. Century of Seabrook, N. D. Wilson, 1954), and also M. B. Belkin (1972), etc. make a plication of small intestinum at acute intestinal impassability, the vast majority of surgeons considers that it should be made only in a stage of remission of a disease when there are no acute manifestations of intestinal impassability. At commissural impassability of intestines sewing together of the inflated loops can lead to damage of an intestinal wall and to peritonitis (see). Besides, at sharply inflated loops of intestines it is difficult to be guided in an abdominal cavity in this connection duration of operation increases that increases quantity of postoperative complications.

Preparation for surgery: in a stage of remission has no features; at acute intestinal impassability (see. Impassability of intestines ) this stage has a number of features.

Anesthesia — as a rule, intubation anesthesia.

Access to an abdominal cavity is provided usually through median laparotomy (see). At repeated numerous interventions it is possible to use cross section. During the opening of an abdominal cavity it is necessary to observe extreme care since damage of the loops of a gut soldered to a postoperative hem is possible.

Diagrammatic representation of stages of operation of Nobl: and — the beginning of the corrugating seam (it is specified by an arrow) on a mesentery of a small bowel; — imposing of a continuous suture (it is specified by shooters) on mesenteric edge of the first loop of a small bowel; in — two knees of a gut are sewed, the corrugating stitch on a mesentery of the following loop of a small bowel is put.

Make full mobilization of a small bowel by crossing of all commissures and unions. After audit of intestines start a plication of small intestinum. For this purpose loops of intestines stack in the form of the vertical or horizontal battery, otstupya on 10 — 12 cm from ileocecal transition. The same site leave free at Treytts's team. Length of each knee of a gut makes from 10 to 20 cm. Fixing is carried out a continuous chrome-plated catgut suture (see. Catgut ), to-ry impose on mesenteric edge of opposite intestinal loops. The seam shall pass to a mesentery, capturing her throughout 5 — 6 cm (fig). At the correct technology of connection intestinal loops grow together without dysfunction or development of impassability.

Various modifications of N. of the lake are offered. So, Seabrook and Wilson (1954), Yu. T. Komarovsky (1962) recommended to sew loops on the middle of distance between mesenteric and free edge for the purpose of the most dense comparison and an union. E. J. Poth with sotr. (1961) suggests to sew a continuous matratsny suture mesenteric edge of a gut. Kenya and Teyme-ret (T. A. E. E. Quenu, G. Thameret, 1951), K. S. Simonyan loops of guts in the form of horizontal batteries consider it expedient to sew. Whyte (R. White, 1956) recommends to fix loops of intestines on the tube which is carried out to a gleam through the entero-ostomy imposed below Treytts's team. Yu. F. Isakov and T. V. Kra-sovskaya (1973) carried out N. by the island by means of glue tsiakrin.

Nek-ry surgeons consider more physiologic operations of sewing together of a mesentery of a small bowel. Chaylds and Phillips (W. A. Childs, R. Century of Phillips, 1960) sew all leaves of a mesentery of a small bowel horizontally located P-shaped silk seams. Yu. T. Komarovsky (1962) puts P-shaped stitches on a mesentery in vertical position, preventing thereby disturbance of blood circulation in vessels of a gut. D. P. Chukhriyenko (1972) suggested to put stitches on a mesentery using basic mylar strips.

In postoperative period (see) for reduction of commissural process nek-ry authors suggest to enter a hydrocortisone or a cortisone, fibrinolysin, Polyglucinum into an abdominal cavity, and for prevention of postoperative paresis to carry out early stimulation of motor function of intestines.

On summary statistics of K. S. Si-monyan, the postoperative lethality makes 7%. The lake peritonitis, fecal fistulas, thrombosis of mezenterialny vessels are the reasons of lethal outcomes after N. In the remote period excellent and good results, according to Nobl, are observed at 97% of patients. On the summary statistics of domestic authors made by V. A. Kostovsky (1973), a recurrence of intestinal impassability after a plication of small intestinum is celebrated at 12,2% of patients.

See also Intestines (operations) .

Bibliography: Belkin M. B. Nobl's operation at acute commissural intestinal impassability, Surgery, No. 10, page 79, 1972; Pancakes N. I. Adhesive desease, its prevention and treatment, L., 1968, bibliogr.; To about m about r about in - with to and y Yu. T., To about r h and N with to and y I. Yu. and Gordiyenko of S. K. Metodik of an ente-roptissiya at postoperative commissural intestinal impassability, Klin, hir., No. 7, page 34, 1962, bibliogr.; To about with t about Sunday to and y V. A. Enteroplikation as one of methods of treatment of an adhesive desease, Works of the 4th congress hir. Grew. Federations, page 215, Perm, 1973; Simonyan K. S. Adhesive desease, M., 1966; Chukhriyenko D. P., White I. S. and Bondarenko V. A. Adhesive desease, Kiev, 1972; Noble T. Century of Plication of small intestine as prophylaxis against adhesions, Amer. J. Surg., v. 35, p. 41, 1937; it, Acute peritonitis, treatment of pathologic process and its immediate aftermath, further experiences with plication, J. int. Coli. Surg., v. 14, p. 66, 1950; Poth E. J., W o 1 m a F. J. a. L y n with h J. B. The plication procedure in the treatment of small bowel adhesions, Surg. Gynec. Obstet., v. 112, p. 343, 1961.

Yu. A. Nesterenko.