Small Bowel Resection Health Article

Definition

A small bowel resection is the surgical removal of one or more segments of the small intestine.

Purpose

The small intestine is the part of the digestive system that absorbs much of the liquid and nutrients from food. It consists of three segments: the duodenum, jejunum, and ileum; and is followed by the large intestine (colon). A small bowel resection may be performed to treat the following conditions:

• Crohn's disease. This condition is characterized by a chronic inflammatory condition that affects the digestive tract. If other treatment does not effectively control symptoms, the physician may recommend surgery to close fistulas or remove part of the intestine where the inflammation is worst.
• Cancer. Cancer of the small intestine is a rare cancer in which malignant cells are found in the tissues of the small intestine. Adenocarcinoma, lymphoma, sarcoma, and carcinoid tumors account for the majority of small intestine cancers. Surgery to remove the cancer is the most common treatment. When the tumor is large, removal of the small intestine segment containing the cancer is usually indicated.
• Ulcers. Ulcers are crater-like lesions on the mucous membrane of the small bowel caused by an inflammatory, infectious, or malignant condition that often requires surgery and in some cases, bowel resection.
• Intestinal obstruction. This condition involves a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through. Intestinal obstruction is usually treated by decompressing the intestine with suction, using a nasogastric
  tube inserted into the stomach or intestine. In cases where decompression does not relieve the symptoms, or if tissue death is suspected, bowel resection may be considered.
• Injuries. Accidents may result in bowel injuries that require resection.
• Precancerous polyps. A polyp is a growth that projects from the lining of the intestine. Polyps are usually benign
  and produce no symptoms, but they may cause rectal bleeding and develop into malignancies over time. When polyps have a high chance of becoming cancerous, bowel resection is usually indicated.

Demographics

According to the National Cancer Institute, adenocarcinoma, lymphoma, sarcoma, and carcinoid tumors account for the majority of small intestine cancers which, as a whole, account for only 1–2% of all gastrointestinal cancers diagnosed in the United States.

Crohn's disease occurs worldwide with a prevalence of 10–100 cases per 100,000 people. The disorder occurs most frequently among people of European origin; is three to eight times more common among Jews than among non-Jews; and is more common among whites than nonwhites. Although the disorder can start at any age, it is most often diagnosed between 15 and 30 years of age. Some 20–30% of patients with Crohn's disease have a family history of inflammatory bowel disease.

The occurrence of polyps increases with age; the risk of cancer developing in an unremoved polyp is 2.5% at five years, 8% at 10 years, and 24% at 20 years after the diagnosis. The risk of developing bowel cancer after removal of polyps is 2.3%, compared to 8.0% for patients who do not have them removed.

Description

The resection procedure can be performed using an open surgical approach or laparoscopically. There are three types of surgical small bowel resection procedures:

• Duodenectomy. Excision of all or part of the duodenum.
• Ileectomy. Excision of all or part of the ileum.
• Jejunectomy. Excision of all or a part of the jejunum.

Open resection

Following adequate bowel preparation, the patient is placed under general anesthesia and positioned for the operation. The surgeon starts the procedure by making a midline incision in the abdomen. The diseased part of the small intestine (ileum or duodenum or jejunum) is removed. The two healthy ends are either stapled or sewn back together, and the incision is closed. If it is necessary to spare the intestine from its normal digestive work while it heals, a temporary opening (stoma) of the intestine into the abdomen (ileostomy, duodenostomy, or jejunostomy) is made. The ostomy is later closed and repaired.

Laparoscopic bowel resection

Laparoscopic small bowel resection features insertion of a thin telescope-like instrument called a laparoscope through a small incision made at the umbilicus (belly button). The laparoscope is connected to a small video camera unit that shows the operative site on video monitors located in the operating room. The abdomen is inflated with carbon dioxide gas to allow the surgeon a clear view of the operative area. Four to five additional small incisions are made in the abdomen for insertion of specialized surgical instruments that the surgeon uses to perform the surgery. The small bowel is clamped above and below the diseased section and this section is removed. The small bowel ends are reattached using staples or sutures. Following the procedure, the small incisions are closed with sutures or surgical tape.