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Small bowel resection

Indications

• Ischaemia, infarction, necrosis
• Tumour

Procedure

1. GA + NGT + Antibiotics / Supine position
2. Midline incision
3. Deliver diseased segment into wound
   • Protect wound edges (with swabs - minimise sepsis)
   • Apply 2 non-crushing clamps to occlude bowel either side of disease segment
4. Incise peritoneum of mesentery along chosen line for division of vessels (transilluminate, then tie with absorbable sutures)
5. Place crushing clamps at 30' angle to bowel and divide close to clamp - allows better perfusion of anti-mesenteric border
   • Cut across bowel with knife, remove diseased section
   • Cover cut ends with antiseptic soaked swabs
   • If bowel ends do not bleed (usually poor blood supply) - resect until health tissue reached
6. Perform anastamosis (two layers - inner including submucosa + outer lembert stitch)
   • Posterior wall first: seromuscular continous
   • Full thickness suture (double ended)
   • Check anastamosis - if looks dusky; wait, observe
7. Close defect (including mesentry - prevents gut herniation) with interrupted sutrues
8. Close abdominal wall

Complications

Physiological