Small Bowel Resection

Small Bowel Resection

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

Small bowel resection is performed under general anaesthesia with the patient in the supine position.  The procedure is performed either open or laparoscopically for the following conditions:

  • Small bowel tumour (benign/malignant).
  • Crohn’s disease resistant to medical treatment.
  • Small bowel ischaemia (i.e. superior mesenteric artery infarction).
  • Radiation or Crohn’s disease induced stricture.
Operative techniques

Open: A midline laparotomy or other appropriate incision is made, the layers are divided and the abdomen is entered.  The diseased segment of bowel is identified and resected.  The two healthy ends are then either anastomosed (using hand sewn or stapled technique) or alternatively a stoma is brought to the skin surface. 

Laparoscopic: 3-5 small incisions are made on the abdomen in order for the camera and instruments to be inserted.  The diseased segment of bowel is identified and resected.  The two healthy ends are then either anastomosed (using hand sewn or stapled technique) or alternatively a stoma is brought to the skin surface.

As the length of the small bowel varies from person to person, the length of small bowel resected is not as important as the amount left behind.  The British Society of Gastroenterology suggests that if there is <200cm small bowel, nutritional of fluid supplements are likely to be needed.  If it is anticipated that there will be <150cm of small bowel remaining it is important to discuss the possibility of the long-term need of total parenteral nutrition.

Following distal ileal resection patients are more prone to the formation of gallstones.  As a consequence of dehydration and abnormal oxalate metabolism, certain patients following small bowel resection will also be more prone to developing kidney stones.

Additional procedures that may become necessary

End-ileostomy/loop ileostomy/Defunctioning stoma/abdominal drain insertion.

Benefits
  • Diagnostic: To obtain tissue for histopathological diagnosis.
  • Therapeutic: Remove diseased segment of small bowel.
Alternative procedures/conservative measures
  • Medical: For Crohn’s disease, medical therapy and immunotherapy can be used to decrease the inflammatory process and reduce the inflammatory process and reduce the risk of stricture formation and fistulation.
  • Surgical: For small bowel structuring disease in patients where length of bowel will need to be conserved, stricturoplasty can be considered as an alternative to small bowel resection.
Serious/frequently occurring risks
  • Bleeding, infection (including intra-abdominal abscess, wound and urinary infection), perforation of bowel, anastomotic dehiscence of leak (1.1%) small bowel syndrome, intestinal failure, entero-cutaneous fistula, incisional hernia, alteration of bowel habit, mortality rate (1.7%).
Blood transfusion necessary
  • Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
  • Cross-match (depending on starting haemoglobin).
Type of anaesthesia/sedation
  • Regional.
  • General anaesthesia.
Follow-up or need for further procedure
  • Routine outpatient review is required.

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