Small intestine (Small bowel) surgery as the name suggests involves surgery of the small intestine either by conventional open surgery or minimal access surgery also called as laparoscopic surgery . The laparoscopic surgery is performed by placing the specialised instruments in the abdomain and performing surgery on the monitor under complete vision. The minimal invasive surgery is established way of performing small bowel surgeries which are well supported by various research and clinical based evidences.
Small bowel surgeries are considered to be major surgeries and involves appropriate team work. With the advancements of techniques and improvisation of surgical skills the surgical results of major liver resections have become excellent with time.
The types of small intestine surgery performed either via open conventional surgery or laparoscopic surgery or laparoscopic assisted surgery are Adhesolysis of small intestine, small intestine resection and anastomoses and small intestine by pass surgery
Indication of Small intestine ( small bowel) surgery
- Perforation of small intestine
- Small bowel diverticulitis or divertuclar disease of small bowel
- Small bowel lipomas
- Small bowel tumours
- Intestinal fistula
- Ischemia if small bowel
- Crohn’s disease of the small bowel
- Meckel’s diverticula of small intestine
- Small intestine adhesions
- Small intestine carcinoid tumours
- Tuberculosis of small intestine
- Internal hernia of small intestine
- Bleeding ulcers in intestine
- Intussception of the small bowel
- Intestinal bands causing obstruction
- Malrotation of small intestine
Once you are planned for surgery the surgeon will explain all the details , it’s risk involved , informed consent and recovery protocols after the surgery they are planning to perform. Usually the length of the procedure will depend upon the extent of the surgery.
- Surgery is performed under General anaesthesia
- Particular position of the patients according to the area of the surgery is given to the patient (commonly done in supine position and position is changed during the surgery depending upon the ease to perform surgery)
- Technically incision is given upon extent of surgery and preference of surgery in cases of open conventional surgery
- In laparoscopic surgery, Small hole are made to enter the abdomain using video scope to assess the complete abdominal cavity and area of the disease.
- Adhesolysis ( removal of adhesions) if any is done and small intestine is completely examined to its complete length. The disease is identified and planned surgical procedure is carried. Please note there is variation of the procedure performed accordingly to the disease.
- Surgery is performed using specialised instruments, energy sources , clips , staplers to separate the diseased colon with healthy margins. The continuity of the alimentary canal is restored using staplers.
- The diseased part is removed and the abdominal drain is placed in abdominal cavity.
Recovery after surgery
- The patient might be kept in surgical intensive care unit for initial observation and management. Bleeding, infection and leak are major risks involve after these surgeries.
- Intensive physiotherapy is advised for enhanced recovery of the patients as breathing might be hampered because of long incisions in case of open surgery and pain associated with them.
- Diet is usually started once your bowel function starts returning after surgery.
- Early mobilisation of the patient is recommended.
- Routine check up up of your blood will be performed to study your recovery and chances of infection.
- Diet is managed with the help of the dietician to enhance your recovery and protein supplements are added.
- The length of stay after the hospital is usually 2-5 days depending upon the extent of surgery and recovery of the patients.
Advantages of Laparoscopic small intestinal(bowel) surgery
- Big incision is avoided which is used in conventional surgery which causes significant discomfort and pain.
- Early recovery of bowel functions
- Early healing of the wound
- Shorter stay of hospital
- Early mobilisation and early return to work
- Scar is minimal
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