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Resection of the small intestine is a complex surgical intervention. Its essence lies in the removal of a certain part of the internal organ, due to which there is a violation of digestion. Excision of a section of the small intestine is prescribed for tumors (benign and malignant), vascular thrombosis, vascular infringement and wounds. The length of the internal organ for each person may differ, which is why the procedure for excising the intestine more than 1,5 meters is considered dangerous by doctors.
Indications and reasons for resection
Resection of the small intestine is an urgent surgical intervention, which is prescribed by a doctor for obstruction, thrombosis and the detection of tumors. If a large section of the intestine is excised to the patient, then after the procedure for 1-2 days the patient suffers from frequent stools, which normalizes after the restoration of the digestive system. After the operation, a person may become disabled, 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 reasons for 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 prescribing a resection, the doctor must conduct a visual examination, look at the medical history. The specialist will refer the patient to laboratory tests of urine and blood. Also, to confirm the need for surgery, 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 assessing the functioning of the liver.
The results of research and a comprehensive diagnosis of the human body allow the doctor to identify problems in the patient’s intestines and prescribe a course of treatment.
Both the doctor and the patient should prepare for surgery. The patient must 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 effects).
It is necessary to drink antibiotics prescribed by the doctor 3-4 days before the procedure. You should also cleanse the intestines with an enema or laxative drugs, and a week before the operation, start adhering 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. For 6-8 hours before the start of surgery, it is forbidden to eat and drink.
About the technique of resection of the small intestine
The excision is done under general anesthesia so that the person does not feel pain and has an easier time undergoing surgery. There are 2 methods of carrying out the procedure: the first is open (the stomach is completely cut), the second is laparoscopic (the specialist makes several small incisions into which cameras, light and the necessary sterile instruments are inserted).
The first method is classical, rarely used. The second method of resection of the small intestine is new, after it there are no scars and scars. Other advantages of laparoscopy include: minimal risk of infection, much shorter postoperative period, less painful recovery process.
Step by step laparoscopic surgery:
- the patient is administered intravenous anesthesia and other sedative medications;
- a large needle is inserted into the abdomen, through which the stomach is filled with carbon dioxide (this is necessary so that the abdominal cavity enlarges and the procedure is easier to carry out);
- the specialist makes from 4 to 6 incisions in the abdomen (a camera with an illuminating flashlight is inserted into one of the holes, and instruments are inserted into the others, for example, clamps, a scalpel and scissors);
- a section of the injured intestine is cut off, the resulting ends are sutured with a needle and thread or connected with special staples;
- cut places are lubricated with iodonate;
- all instruments are removed, gas is evacuated, the incisions 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 switch from laparoscopy to open (classical) resection.
Features of the procedure with the junction of the intestines “end to end” and “side to side”
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 given anesthesia. Next, a probe is inserted through the stomach, an incision is made by the surgeon in the abdomen 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 vessels, while small vessels must be tied with a thread.
To perform an anastomosis, the diseased intestine should be taken to the side, and then the incision should be sutured with a treble thread using the Lambert method (the surgeon’s technique allows you to reduce tension in the incised areas).
In a side-to-side anastomosis, after the bowel has been divided, the ends should be clamped together with a continuous turning suture. When the surgeon removes the clamps, the sutures are tightened to avoid bleeding and occlusion of the lumen.
The specialist must ensure that the blood circulation is not disturbed; for this, the extreme suture extends the edge of the mesentery. The walls are cut with a knife or scalpel, then they are separated with scissors. The mesentery is approached by silk sutures in the form of knots.
Post-operative care
After surgery in the hospital, the patient must be injected with Ringer’s lactate solution intravenously, it makes up for the lack of fluid in the body. The patient is prescribed antibiotics. Even before the procedure begins, a catheter is fixed to him, through which urine will be excreted after surgery.
A few days after the resection, decompression will be carried out, its essence is to suck fluid from the stomach. Decompression is needed until the small intestine recovers.
After the patient has been discharged from the hospital, he must go for an examination to the attending doctor.
Issues related to physical activity, habitual regimen and lifestyle, driving vehicles, taking a bath and shower (in the first 2-3 days after resection it is forbidden to wet the seams with water), performing special exercises that prevent thrombosis of the lower extremities are discussed with the specialist.
You can switch to a natural (habitual) diet 5-6 months after the excision of the small intestine. After the operation, 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.
If you experience rectal bleeding, cough or chest pain, frequent urination, blood in your urine, and abdominal discomfort, seek immediate medical attention.
In the period after the operation, the patient sits on a strict diet. Many of the foods are forbidden to eat: fatty and fried foods, legumes, foods that swell the stomach, some fruits (pears, apples). Do not drink carbonated water. It is recommended to give up bad habits such as smoking and drinking alcohol. The patient needs to visit the doctor regularly and report on his health. The period of full recovery most often takes from 6-9 months to 1-2 years.