Jim Buscher
University of Kentucky College of Medicine
Class of 2014
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Brief History of small bowel resection
Alternate names
Advantage of Laparoscopy
When to perform procedure
Risks of Small Bowel Resection
Patient Presentation
Equipment Needed
OR Setup
Port Placement
Key Steps
Post –Operative Care
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The first reported small bowel was reported to
have taken place in 1727 by Ramdohr.
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By 1836 at least 10 more procedures had been
performed by French, German, and English
surgeons
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Removed 2 feet of gangrenous intestine
5 cured, 2 with artificial anus, 2 died
Became a recognized surgical procedure in
1875 by Kuster.
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Alternative Names
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Small intestine surgery; Bowel resection - small
intestine; Resection of part of the small intestine;
Enterectomy
Laparoscopic Advantages
Quicker recovery time
 Faster return to eating solid foods
 Less pain
 Fewer scars
 Lower risk of infection
 Fewer post-operative complications
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A blockage in the intestine caused by scar tissue or
deformities
Bleeding, infection, or ulcers caused by
inflammation of the small intestine. Three
conditions that may cause inflammation are
regional ileitis, regional enteritis, and Crohn’s
disease.
Injuries to the small intestine
Cancer
Precancerous polyps (nodes)
Benign tumors
 http://www.nlm.nih.gov/medlineplus/ency/article/002943.htm
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Damage to nearby organs in the body
Wound infections
Wound breaking open
Bulging tissue through the incision, called an incisional hernia
Short bowel syndrome (when a large amount of the small intestine
needs to be removed)
The ends of your intestines that are sewn together may come
open. This is called anastomosis. This may be life threatening.
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Anastamotic leak
Scar tissue may form in your belly and cause blockage of your
intestines.
Problems with your ileostomy
Inadvertant enterotomy
Anastomotic stricture
Hemorrhage
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Unlike some diseases there are many different
signs and symptoms that may be associated
with someone who must undergo a small
bowel resection.
Pain
 Internal bleeding
 Blockage may cause vomiting
 Polyps (seen by colonoscopy)
 Tumors found by MRI
 May be found during trauma
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Atraumatic bowel graspers
Laparoscopic scissors
Harmonic scalpel
Scalpel
Suction device
GIA endostapler
3 trocars (one 10mm and two 5mm)
30 degree scope
Suture
Various clamps and scissors
Hand port (Optional)
TA Stapler (Optional)
On-Q painbuster (optional)
•Patient begins in supine
position
•Move patient into
positions later to allow
gravity to shift unwanted
organs out of the way.
•Two screens to allow
surgeons on both sides of
patient to see
•Anthesiologist positioned
behind patient’s head and
scrub nurse positioned near
the feet (not shown)
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One 10 mm trocar
placed in umbilical
incision for camera
Two 5 mm trocars
placed in abdomen to
triangulate on area to
be resected.
Trocar placed in abdomen via the Opti-view
This can be seen on the left going through the
layers of the abdomen.
Step 1:
•Move along bowel using atraumatic
bowel graspers to find the source of the
desired bowel for excision.
•Note from surgeon be sure to grab
the fat near the bowel and not the
bowel itself this will reduce the risk of
tearing.
•Bowel may have attachments so be sure
to mobilize the bowel . This is important
because the small bowel will be extracted
from the abdomen.
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Step 2:
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After finding desired small
bowel, use the harmonic scalpel
to dissect mesentery and ligate
the arteries of the Superior
Mesenteric Artery
If bleeding occurs suction may
be used to remove interfering
blood.
Caution:
The Harmonic Scalpel is very
hot. Be sure not to damage
internal structures by
touching them with the tip
after cutting.
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Step 3:
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Once vasculature has been minimized to desired area, remove
the camera and trocar and lengthen the umbilical incision.
This lengthening will allow for the small intestine to be
removed from the abdominal cavity.
•A hand port may be used
during this step of the
procedure. If a hand port is
used, the umbilical incision
will be lengthened, the port
placed, and then the intestine
will be pulled from the
abdomen.
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Step 4:
Locate desired portion of
bowel and using
mosquito clamps, clamp
around the edge of the
area to be removed.
 Cut in between the two
clamps.
 This procedure will be
done on both sides of the
intestine to be removed.
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Step 5:
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Perform a side-to-side
anastamosis by aligning the
two healthy small bowel
segments side-by-side with
the openings next to one
another. The GIA
endostapler may now be
inserted into the openings
and applied. This will
anastamose the intestine
leaving one opening at the
end.
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Step 6:
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Close the opening of the anastamosis.
Be sure to place other sutures around the
anastamosis in order to reinforce the intestine.
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Step 7:
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Return bowel to abdomen through the umbilical
incision.
 If desired, place On-Q Painbuster in patient.
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Step 8: Close incisions left over from trocars
and umbilical incision.
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Hospitalization for 3-7 days.
Ingestion of liquids is allowed by the second
day.
Slowly thicken liquid over time until solid
foods may be ingested
Pain and wound management
The longer the length of bowel removed the
longer the hospital stay and the longer one will
be unable to eat solid foods.
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E., John, L. J., and Panajiotis N.. Minimally
Invasive Surgical Procedures and Anatomy.
Springer Verlag, 2005. 255-266. Print.
http://www.nlm.nih.gov/medlineplus/ency/
article/002943.htm
Smith, James, Abdominal Surgery v. 2., Bristol,
1897. 589-591. Digital Print.