Background 

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 

1. Perforation of small intestine 
2. Small bowel  diverticulitis or divertuclar disease of small bowel
3. Small bowel lipomas 
4. Small bowel tumours 
5. Intestinal fistula 
6. Ischemia if small bowel 
7. Crohn’s disease of the small bowel 
8. Meckel’s diverticula of small intestine 
9. Small intestine adhesions
10. Small intestine carcinoid tumours 
11. Tuberculosis of small intestine 
12. Internal hernia of small intestine 
13. Bleeding ulcers in intestine 
14. Intussception of the small bowel 
15. Intestinal bands causing obstruction 
16. Malrotation of  small intestine 

Technical Insights 

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.  

1. Surgery is performed under General anaesthesia
2. 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) 
3. Technically incision is given upon extent of surgery and preference of surgery in cases of open conventional surgery 
4. 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.
5. 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. 
6. 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. 
7. The diseased part is removed and the  abdominal drain   is placed  in abdominal cavity.

Recovery after surgery 

1. 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. 

1. 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. 

1. Diet is usually started once your bowel function starts returning after surgery.

1. Early mobilisation of the patient is recommended.

1. Routine check up up of your blood will be performed to study your recovery  and chances of infection. 

1. Diet is managed with the help of the dietician to enhance your recovery and protein supplements are added.

1. 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 

1. Big incision  is avoided which is used in conventional surgery which causes significant discomfort and pain.
2. Early recovery of bowel  functions 
3. Early healing of the wound
4. Shorter stay of hospital 
5. Early mobilisation and early return to work 
6. Scar is minimal 

To consult with best team of General and minimal access surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details.