Resection of the small intestine is a complex surgical intervention. Its essence is to remove a certain part of the internal organ, due to which digestive disorders are observed. Excision of the small intestine is prescribed for tumors (benign and malignant), vascular thrombosis, strangulation of vessels and wounds. The length of the internal organ of each person may differ, which is why doctors consider the procedure for excision of the intestine more than 1.5 meters as dangerous.
Indications and causes of resection
A small bowel resection is an urgent surgical operation that is prescribed by a doctor for obstruction, thrombosis and the detection of tumors. If the patient is excised a large area of the intestine, then after the procedure for 1-2 days the patient suffers from frequent stool, which normalizes after the digestive system is restored. After the operation, a person may become incapacitated, and even dietary nutrition will not be able to put the patient on his feet. According to statistics, people after resection live 5-10 years less.
Excision of the small intestine is carried out in the most extreme cases, when other therapeutic methods are not able to cure a person.
The main causes of the operation are: gastric ulcer or bleeding, tumor-like neoplasms, precancerous polyps found in the small intestine, chronic inflammatory disease of the gastrointestinal tract, obstruction, trauma to the abdominal cavity, as a result of which the intestine was mechanically injured.
Features of preparation for surgery
Before appointing a resection, the doctor should conduct a visual examination, see the medical history. The specialist will refer the patient to laboratory tests of urine and blood. Also, to confirm the need for surgical intervention, you need to get the result of an x-ray of the chest and abdomen.
If necessary, magnetic resonance imaging (MRI), electrocardiography (ECG), computed tomography (CT) can be performed. Sometimes the patient is sent for laboratory tests aimed at evaluating the liver.
The results of studies and a comprehensive diagnosis of the human body allow the doctor to identify problems in the intestines of the patient and prescribe a course of treatment.
Both the doctor and the patient should prepare for surgery. The patient should adhere to the following recommendations of a specialist: a week before the operation, it is forbidden to drink medicines (acetylsalicylic acid, drugs with anti-inflammatory and blood thinning actions).
It is necessary to drink antibiotics prescribed by the doctor 3-4 days before the procedure. You should also clean the intestines with an enema or laxative drugs, and a week before the operation, start to adhere to a diet, it is advisable to exclude foods that contain fiber from the diet.
During the preoperative period, it is recommended to drink 2 liters of pure water during the day. It is forbidden to eat and drink 6-8 hours before the start of surgery.
About the technique of resection of the small intestine
Excision is done under general anesthesia so that the person does not feel pain and easier to undergo surgery. There are 2 methods for carrying out the procedure: the first is open (the abdomen is completely cut), the second is laparoscopic (the specialist makes several incisions of small sizes into which cameras, light and necessary sterile instruments are inserted).
The first method is classic, rarely used. The second method of resection of the small intestine is new, after it there are no scars and scars. Other benefits of laparoscopy include: minimal risk of infection, a much shorter postoperative period, and a less painful recovery process.
Phased laparoscopic surgery:
- the patient is given intravenous anesthesia and other sedative medications;
- a large needle is inserted into the abdomen, through it the abdomen is filled with carbon dioxide (this is necessary so that the abdominal cavity increases and the procedure is easier to carry out);
- the specialist makes from 4 to 6 cuts in the abdomen (a camera with a illuminating flashlight is inserted into one of the holes, and tools, for example, clamps, a scalpel and scissors, are introduced into the others);
- a section of the injured intestine is cut off, the formed ends are sewn together with a needle and thread or connected with special staples;
- cut places are lubricated with iodonate;
- all tools are removed, gas is pumped out, cuts are sutured and a sterile dressing is applied.
Surgical intervention lasts from 2 to 3 hours. It happens that during the operation the surgeon can go from laparoscopy to open (classical) resection.
Features of the procedure with the junction of the intestines "end to end" and "side to side"
An end-to-end anastomosis refers to classical surgical interventions and has the following stages: the patient lies on his back and finds a comfortable position, he is anesthetized. Then a probe is inserted through the stomach, an incision is made in the abdomen by the surgeon and an autopsy is performed (the main thing is not to touch the navel).
The specialist mobilizes the site of the diseased small intestine. The surgeon makes excisions as close as possible to the damaged intestine and blood vessels, while small vessels must be connected with a thread.
To carry out anastomosis, the diseased gut should be taken to the side, and then the incision should be stitched with a treble using the Lambert method (the surgeon's technique allows reducing tension in the cut places).
With a side-to-side anastomosis, after separation of the intestine, the ends should be connected with clamps using a continuous turning seam. When the surgeon removes the clamps, the sutures are tightened to avoid bleeding and stopping the lumen.
The specialist must make sure that blood circulation is not disturbed, for this the extreme suture extends the edge of the mesentery. The walls are dissected with a knife or scalpel, then they are separated with scissors. The mesentery is approached by silk sutures in the form of knots.
After the operation in the hospital, the patient must be given an intravenous solution of Ringer's lactate, which makes up for the lack of fluid in the body. The patient is prescribed antibiotics. Before the procedure begins, a catheter is fixed to it, through which urine will be excreted after surgery.
A few days after the resection, decompression will be carried out, its essence is to aspirate fluid from the stomach. Decompression is needed until the small intestine is restored.
After the patient was discharged from the hospital, he should go for an examination to the treating doctor.
The specialist discusses issues related to physical activity, habitual routine and lifestyle, driving vehicles, taking a bath and shower (it is forbidden to wet the seams with water in the first 2-3 days after resection), and performing special exercises to prevent thrombosis of the lower extremities.
You can switch to natural (habitual) nutrition 5-6 months after excision of the small intestine. After surgery, there is a risk of the following symptoms: fever, divergence of staples or sutures, redness and swelling of the sutures, discharge from the sutures, constipation or diarrhea, pain in the abdominal cavity, nausea, vomiting.
For rectal bleeding, coughing, or pain in the chest area, frequent urination, blood in the urine, and abdominal discomfort, seek medical help immediately.
In the period after surgery, the patient sits on a rigid diet. Many of the foods are forbidden to eat: fatty and fried foods, legumes, foods that make the stomach swell, some fruits (pears, apples). You can not drink sparkling water. It is recommended to give up bad habits, such as smoking and drinking alcohol. The patient needs to visit a doctor regularly and report on his health. The period of full recovery most often takes from 6-9 months to 1-2 years.