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October 1955

The Noble Plication Operation for Chronic Recurring Intestinal Obstruction

AMA Arch Surg. 1955;71(4):518-522. doi:10.1001/archsurg.1955.01270160044005

Adhesions causing intestinal obstruction have always presented one of the most difficult problems in surgery. Adhesions between adjacent loops of intestine and the parietal peritoneum are an almost invariable complication of abdominal surgery, but in the great majority of cases these produce no symptoms. However, in a small number of cases complications do arise in the form of recurring intestinal obstruction. Lysis of adhesions by surgery or by decompression by long tubes often is followed by only temporary relief. All too frequently the situation becomes progressively worse after successive laparotomies, and many of these patients finally present severe nutritional problems. A certain number become narcotic addicts in addition to their chronic invalidism, which often adds to the despair of the surgeon. Since 1949 an increasing number of articles have appeared in the surgical literature attesting to the fact that the plication procedure offers the only practical method available for use