Effect of variation in length of decompression tube upon bowel wall

Although it has long been known that the small bowel pleats itself along the long intestinal decompression tube as it passes downward, no previous studies have been under-taken to demonstrate differences that occur by the use of different lengths of tube. The importance of such observations is that the optimum length of tube to be passed is that length which best decompresses the bowel and least interferes with the normal physiology of the gastrointestinal tract. This latter consideration is of the utmost importance if the tube is to remain within the bowel for any length of time. Studying this problem by comparison between roentgen studies preoperatively and the finding at operation demonstrates that the shorter the length of tube down the bowel, the tighter the plication of the bowel about this tube. As a result of this there is the greatest impairment of peristaltic activity and the greatest decrease in absorptive area. The tighter the plication of the bowel upon the tube, the more prone is intussusception to occur. A 6 foot long tube down the gastrointestinal tract appears to be far better than a 4 foot length of tube because the plication is much looser and peristaltic activity unimpaired to a great extent. The 10 foot long tube results in the least interference with the normal physiology of the bowel. Peristaltic activity is unimpaired and the maximum area of mucosa is available for absorption and secretion. Intussusception is least likely to occur with this length of tube. There is little point in pushing more than 6 feet of tube down the gastrointestinal tract if the bowel will not accommodate itself to this length of tube of its own accord. To do so merely results in looping of the tube within the bowel and knot formation. Emphasis is placed upon the point that the intestinal tube must not be fastened to the face of the patient. By leaving the tube free the swallowing acts of the patient, ambulation and the return of peristaltic activity usually result in the tube being slowly pulled down the gastrointestinal tract without being pushed by the surgeon. Such conditions are ideal because the bowel will only pull down sufficient tubing to which it can accommodate itself. A dependence upon the normal physiologic mechanism by which foreign bodies pass along the gastrointestinal tract results in the least interference with this mechanism. Looseness of plication of the bowel upon such tubes is the rule. In those cases in which the tube is fastened to the face and the intestinal musculature pulls upon the tube head against the resistance of it being fastened above plication is tight as a rule. The degree of plication depends upon the length of tube down the bowel. The shorter the length of tube the tighter the plication.