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Institute of Laparoscopic Surgery

Leparoscopic Surgery Training

Surgery of Small Intestine

Laparoscopic surgery is a minimally invasive procedure used to treat diseases of the gastrointestinal tract. It requires tiny "keyhole" incisions in the abdomen unlike traditional open surgery where a long incisional cut is required in the abdomen.

 

Surgery of the small intestine

Surgery of the small intestine may be indicated in patients presenting with Strictures, benign tumors and Meckel’s diverticulum. Surgery aims at removing the compromised sections of the small intestine.

 

Strictures

Strictures are the constricted areas of the intestine that block the contents from passing down.

 

The main reasons for the formation of strictures is inflammatory bowel diseases namely- Ulcerative colitis and Crohns disease. Strictures may also develop due to tumors, adhesions and radiation therapy. Chronic inflammation of the bowel mucosa followed by scarring of the tissue can also subsequently lead to intestinal obstruction.

 

Strictures may be asymptomatic if they do not cause significant blockage, however, significant blockage may cause abdominal pain, cramps, nausea, vomiting, bloating and inability to pass stools.

 

Untreated strictures may lead to perforation (a hole that develops in the intestinal wall) of the bowel. Perforation may cause severe complications like peritonitis (infection of the abdominal cavity), fistulas, abscesses and bacterial overgrowth.

 

An abdominal X ray or CT scan is used to diagnose strictures.

Surgery is recommended for patients with strictures to relieve the intestinal obstruction. There are two ways to perform the surgery:

  • Open surgery
  • Laparoscopic surgery

 

In the laparoscopic surgery, the surgeon makes two-three tiny incisions in the abdomen and enters laparoscope and other surgical instruments through these incisions. The surgeon locates the stricture and unblocks it. Compromised sections of the intestine are removed and the healthy ends are rejoined with staples or stitches. Sometimes when the ends cannot be reconnected, a colostomy or ileostomy may need to be performed.

 

In the open surgery, a large surgical cut is made across the left or middle of the abdomen.

 

Why Laparoscopic surgery over open surgery?

Laparoscopic surgery is less painful and has fewer complications as the abdominal muscles are not cut. The recovery is faster and the patients are mobile within a few hours after the surgery and may be discharged on the same day of the surgery. The cosmetic results are excellent as compared to an Open surgery.

 

Meckel's Diverticulum

Meckel’s diverticulum is a congenital outpouch that develops in the wall of the small intestine which may contain tissue similar to the stomach and pancreas.

 

What causes Meckel’s Diverticulum?

By the seventh week of pregnancy, the vitelline duct (connecting the fetus with the yolk sac) is absorbed into the fetus. Failure of absorption into the fetus leads to the formation of Meckel’s Diverticulum.

 

Most cases of Meckel’s Diverticulum are asymptomatic however, the symptoms may include inflammation of the intestinal wall, ulcers, bleeding, pain and cramps, intestinal obstruction and tenderness near the navel. If a Meckel’s Diverticulum bleeds, surgical removal is recommended.

 

The surgery may be performed laparoscopically or as an open procedure. In the laparoscopic technique, two to three tiny incisions are made in the abdomen and a laparoscope is inserted through one of the incisions which enables the surgeon to view the abdomen on a video monitor. Surgical instruments are inserted through the other incisions. The surgeon removes the Meckel's diverticulum along with the surrounding compromised portions of the small intestine. The healthy ends of the remaining small intestine is joined back using staples or stitches. In an open surgery, a large abdominal incisional cut is made and the remaining technique remains the same.

 

Laparoscopic surgery is less painful and has fewer complications as the abdominal muscles are not cut. The recovery is faster and the patients are mobile within a few hours after the surgery and may be discharged on the same day of the surgery. The cosmetic results are excellent as compared to an Open surgery.

 

Benign tumors

Most tumors of the small intestine are asymptomatic or silent for long periods. Some benign tumors may become malignant with time. Symptomatic tumors may cause nausea, vomiting, bleeding, ulcers and bowel obstruction.

 

Benign tumors of the small intestine include:

  • Leiomyoma- These benign tumors develop in the muscle layers of the small intestine and may become malignant. They cause ulcers and bleeding leading to anemia. Biopsy sampling and subsequent surgical removal is advised.
  • Adenomas- These are benign tumors that develop in the duodenum and have malignant potential. They become symptomatic due to bowel obstruction and need to be surgically removed.
  • Hemangiomas- These are highly vascular benign tumors that develop in the wall of the small intestine. They are known to cause gastrointestinal bleeding and subsequent anemia. In case of significant bleeding, surgical removal is advised.
  • Lipomas- These benign tumors form in the wall of the small intestine due to accumulation of fatty tissues. They do not become malignant however, may cause bleeding due to ulceration and obstruction. Surgical removal is advised in case of significant bleeding.

 

Surgical removal of these benign tumors may be performed in two ways:
  • Open surgery
  • Laparoscopic surgery

 

In the open surgery, a large surgical cut is made in the abdomen. The surgeon locates the tumor and surgically removes it. The incision is closed with stitches.

 

In the laparoscopic surgery, the surgeon makes two-three tiny incisions in the abdomen and enters laparoscope and other surgical instruments through these incisions. The surgeon locates the tumor and removes it.

 

Why Laparoscopic surgery over open surgery?

Laparoscopic surgery is less painful and has fewer complications as the abdominal muscles are not cut. The recovery is faster and the patients are mobile within a few hours after the surgery and may be discharged on the same day of the surgery. The cosmetic results are excellent as compared to an Open surgery