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June 1955

The Noble Plication Procedure: Application to Acute and Chronic Recurrent Small Bowel Obstruction

Author Affiliations

Los Angeles
From the Department of Surgery, University of Southern California School of Medicine and the Hospital of the Good Samaritan.

AMA Arch Surg. 1955;70(6):801-807. doi:10.1001/archsurg.1955.01270120009002

The most frequent cause of small bowel obstruction is chronic adhesive peritonitis following abdominal surgery. The patient who has had recurrent attacks of acute obstruction presents a difficult and distressing problem to the surgeon. Such a patient at operation has extensive adhesions with matted loops of small bowel. After enterolysis, extensive damage to visceral and parietal peritoneum results. Avoidance of further episodes of obstruction in this patient lies not in the attempt to prevent adhesions but in controlling adhesions certain to form.

In 1937 Noble1 applied the principal of plicating the bowel, forming loops in such a fashion that kinks and obstruction might not develop. Subsequent observers, notably Seabrook,* Poth,4 and Robert Smith5 have reported their experiences with this procedure and were well satisfied with the results.

During the year 1949, the surgical services of the University of Southern California School of Medicine established policies for the

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