Small Bowel Resection
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 tumor (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.
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.