General

Small Bowel Resection with Primary Anastomosis

SMALL BOWEL RESECTION WITH PRIMARY ANASTOMOSIS

Indication: Small bowel ischaemia/infarction, Crohn's stricture, small bowel obstruction with non-viable bowel, small bowel perforation, trauma, or resection of small bowel tumour.

Patient Position: Supine.

Anaesthesia: General.

Prophylactic Antibiotics: Broad-spectrum.

Incision: Midline laparotomy (or laparoscopic approach for elective cases).

Procedure:
1. Abdomen entered and explored. Small bowel assessed for viability — colour, peristalsis, Doppler signal of mesenteric vessels.
2. Non-viable or diseased segment identified and isolated.
3. Mesentery divided: vessels ligated or clipped in a V-shaped mesenteric excision, preserving blood supply to the remaining bowel ends.
4. Bowel divided proximally and distally at points of healthy, well-perfused tissue.
5. Segment removed.
6. Primary anastomosis: end-to-end (hand-sewn in two layers or stapled side-to-side functional end-to-end). Anastomosis confirmed for integrity and absence of leak.
7. Mesenteric defect closed.
8. Abdomen closed. Drain not routinely required for small bowel anastomosis.

Finding(s): [Indication: specify. Segment excised: __ cm. Proximal and distal bowel viability: confirmed at resection margins. Anastomosis: hand-sewn / stapled — satisfactory. Mesenteric defect: closed.]

Complications Noted: [None / specify.]

Postoperative Instructions: Enhanced recovery. Early oral fluids. Diet advance as tolerated. If extensive resection: nutritional assessment and TPN planning for short bowel syndrome prevention.