Laparoscopic Small Bowel Resection and Anastomosis



Laparoscopic Small Bowel Resection and Anastomosis





Depending on the habitus of the patient, the nature of the pathology, and the mobility of the small bowel, there are several approaches that can be used in laparoscopic small bowel resection and anastomosis. The technique shown here uses laparoscopic mobilization and mesenteric division, followed by extracorporeal completion of resection and anastomosis. It is also possible to construct a fully intracorporeal anastomosis. The advantages are minor, however, because an incision must be made to retrieve the specimen. In some circumstances, the entire mesenteric division and anastomosis may be done after exteriorizing the specimen—the laparoscope then is used simply to localize and elevate the relevant loop. References at the end of this chapter give further technical tips on applications in the setting of adhesive small bowel obstruction and small bowel tumors.

SCORE™, The Surgical Council on Resident Education, classified laparoscopic small bowel resection as an “essential uncommon” procedure.

STEPS IN PROCEDURE



  • Obtain laparoscopic access


  • Explore abdomen and identify segment to be resected


  • Suspend the selected loop with traction sutures brought out through anterior abdominal wall


  • Create window in mesentery at antimesenteric border of bowel


  • Divide mesentery with vascular endoscopic stapler


  • Make small incision and deliver loop of intestine


  • Perform extracorporeal division of bowel and anastomosis


  • Close mesenteric defect


  • Return bowel to abdominal cavity


  • Close incision and any trocar sites over 5 mm

HALLMARK ANATOMIC COMPLICATIONS



  • Missed lesion


Orientation and Initial Mobilization (Fig. 93.1)


Technical Points

Place the first trocar at the umbilicus and explore the abdomen. If the lesion is in the proximal small intestine, set up the laparoscopic field and trocar sites to allow comfortable access to the left upper quadrant (Fig. 93.1A). For middle or distal small intestine, a right lower quadrant field is more appropriate (Fig. 93.1B). Explore the abdomen and trace the small bowel (Fig. 93.1C) from the ligament of Treitz to the terminal ileum. Confirm the location of the segment to be resected. Identify the proximal and distal resection margins.

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Sep 14, 2016 | Posted by in GENERAL SURGERY | Comments Off on Laparoscopic Small Bowel Resection and Anastomosis

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