Small bowel resection

Technique

• Run small bowel from ligament of Treitz to ICJ
• Identify segment to resect
• Open resection
  • Set-up
    • Expose the bowel on a moist pad
    • Select limits of resection and make mesenteric windows adjacent to bowel
    • Score the serosa in a V shape through the superficial peritoneal layer only
    • Divide the deeper layer of mesentery
      • LigaSure
      • Artery clips/Roberts and 2/0 vicryl ties
    • Resection
      • Non-crushing intestinal clamps on the 'keep' sides with a single click 5cm away from resection margins, and Allen clamps on the 'specimen' side (angle them slightly to preserve perfusion)
      • Scalpel division of bowel, or just make enterotomy and stapled anastomosis
    • Anastomosis (sutured or stapled)
      • See separate topic under 'colorectal'
    • Close mesenteric defect and ideally place omentum over the anastomosis
  • Closure

Intra-op dilemmas

• Anastomosis dusky
  • Resect a couple more cm and redo

For the anastomosis, see separate topic 'anastomosis' under 'colorectal operations'