Laparoscopic Small Bowel Surgery

What is the small bowel?

The small bowel, or small intestine, consists of a flexible tube many feet long that starts at the stomach and ends in the colon. Its surface absorbs water and nutrients from food.

Diseases

Surgical diseases that affect the small bowel include:

  • Crohns Disease
  • Obstruction (blockage)
  • Tumors (growths)
  • Carcinoid Tumors
  • Adenocarcinoma
  • Benign tumors

Symptoms

Symptoms of small bowel disease include rectal bleeding, cramping, nausea, abdominal pain, and weight loss, among others.

Diagnosis

Most of the symptoms of small bowel disease are also present in other, more common, diseases. This can make diagnosis of small bowel problems difficult. Your doctor will start with a detailed history and physical exam. Other studies may include:

CT scan

Upper GI series with small bowel follow through (x-rays following liquid barium through the intestines)

Endoscopy Endoscopy involves passing a long tube with a light and camera down the throat or through the anus (colonoscopy). The small bowel is so long that it is difficult to see all of it this way, but advances are being made that allow a better look at the small bowel. This includes capsule endoscopy in which a tiny camera is swallowed in a pill. It takes pictures of the small bowel as it passes through and radios them out to a computer where your doctor can look at them.

Treatment options

While Crohns disease can often be treated (at least initially) with medicines, obstruction and tumors usually require surgery. Traditionally, operations on the small bowel required a large abdominal and/or pelvic incision, which often required a lengthy recovery. New instrumentation and techniques allow the surgeon to perform the procedure through several small incisions, what we now refer to as minimally invasive, laparoscopic, or laparoscopic-assisted surgery.

Description

Minimally invasive or laparoscopic surgery involves using multiple trocars (thin tubes) placed through 3 to 5 small incisions. These incisions are usually less than 0.5 cm (less than inch). Carbon dioxide gas is then used to slowly inflate the abdomen. A thin telescope is placed through one of the trocars. This allows the surgical team to view the inside of the abdomen on a TV monitor. Specialized instruments are placed through the other trocars to perform the operation. For small bowel surgery, one of the incisions is enlarged to remove the piece of bowel. This larger incision can also be made initially, allowing one hand to be placed within the abdomen along with the camera and long instruments to assist with the operation. The procedure is performed under general anesthesia.

Advantages

Results are different for each procedure and each patient. Some common advantages of minimally invasive colorectal surgery are:

  • Shorter hospital stay
  • Shorter recovery time
  • Less pain from the incisions
  • Faster return to normal diet
  • Faster return to work or normal activity
  • Better cosmetic healing

Many patients qualify for laparoscopic or minimally invasive surgery. However, some conditions may decrease a patients eligibility, such as previous abdominal surgery, cancer (in some situations), obesity, variations in anatomy or advanced heart, lung or kidney disease.

Before Surgery

Before you go to surgery, you will need to be evaluated by your primary doctor and your surgeon. You may need further tests such as a colonoscopy, barium enema, EKG, chest x-ray, CT scan of the abdomen, and/or blood work. Your surgeon or primary doctor will order these tests.

Small bowel surgery may require some form of bowel preparation. A bowel preparation should be followed by only a liquid diet and no solids for 8 hours prior to surgery. You may be instructed to stop taking certain home medications. These include blood thinners, warfarin, aspirin and ibuprofen. You should notify your surgeon of ALL current medications during your evaluation

Patients are usually admitted to the hospital the day of surgery.