Operational key points of super-low placement of an intestinal decompression tube and its clinical efficacy in elderly patients with incomplete small bowel obstruction.

Abstract

Objective: To summarize the key operational points for super-low placement of intestinal decompression tubes and compare the short-term outcomes between super-low placement and traditional placement in elderly patients with incomplete small bowel obstruction.

Methods: Seventy-eight elderly patients (aged ≥ 60 years) with incomplete small bowel obstruction following abdominal surgery admitted to Fujian Medical University Union Hospital between January 2014 and December 2024 were retrospectively enrolled. The super-low group comprised 55 patients treated with the super-low placement of an intestinal decompression tube. The traditional group comprised 23 patients treated with the traditional placement of intestinal decompression tubes. Short-term outcomes were compared between the two groups.

Results: The key operational points for super-low placement of the intestinal decompression tube involve three steps: (1) simultaneous insertion of the catheter and guidewire through the cardia; (2) advancement of the guidewire as deeply as possible; and (3) advancement of the catheter over the guidewire. No significant differences were observed in the baseline clinical characteristics between the two groups. The conservative treatment success rate was significantly greater in the super-low group than in the traditional group (89.1% vs. 69.6%, P = 0.035). The postplacement hospital stay was significantly shorter in the super-low group (7.8 ± 4.0 days vs. 16.1 ± 10.6 days, P < 0.001). Compared with the traditional group, the super-low group also demonstrated significantly shorter times to abdominal symptom relief (2.7 ± 2.3 days vs. 5.4 ± 5.0 days, P < 0.001) and time to resumption of flatus/defecation (4.6 ± 3.3 days vs. 8.1 ± 5.3 days, P = 0.005).

Conclusion: Three key operational points for the super-low placement of intestinal decompression tubes were identified to facilitate learning and dissemination. Super-low placement improved the success rate of conservative treatment and reduced the length of hospital stay in elderly patients with incomplete small bowel obstruction.