Paediatric umbilical hernioplasty.

Ann R Coll Surg Engl 2008; 90: 425–436 426 sigmoidoscopy. To enable placement of the rectal tube, an absorbable suture is tied in a loop through the distal aperture of the rectal tube. The flexible sigmoidoscope pulls the rectal tube ‘piggy-back’ style to an appropriate position in the sigmoid colon. An endoscopic clip applicator is passed through the biopsy channel of the endoscope; the loop of suture tied to the rectal tube is placed in the jaws of the endoclip. The rectal tube is placed under direct vision and the attached suture is fixed to the colonic mucosa with the endoclip (Figs 1 and 4). This allows secure fixation of the rectal decompression tube thereby minimising short-term recurrence. The tube can be later removed easily in the ward by maintaining firm traction.