General Surgery

Small Bowel Resection

OPERATION: Small Bowel Resection and Primary Anastomosis
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Gentamicin and Metronidazole at induction
POSITION: Supine. VTE prophylaxis. Urinary catheter.

INDICATION:
[Ischaemia / incarcerated hernia / Crohn's stricture / tumour / trauma]. [Segment involved, length].

INCISION: Midline laparotomy / [minimally invasive approach if elective].

PROCEDURE:
WHO Checklist performed. Abdomen opened and explored. Small bowel run systematically from duodenojejunal flexure to terminal ileum. Segment to be resected identified — [location, length, reason: non-viable / strictured / involved by tumour].

Vascular supply to resection segment identified by transillumination of the mesentery. Mesentery divided between successive artery forceps in the avascular windows, with vessel ligation. For malignant pathology, a V-shaped mesenteric resection taken to maximise lymphadenectomy without damage to main superior mesenteric vessels.

Bowel divided at proximal and distal resection margins with GIA stapler / clamps. Specimen excised.

End-to-end anastomosis fashioned: [hand-sewn, two-layer / stapled side-to-side isoperistaltic] using [absorbable suture / stapler]. Mesenteric defect closed to prevent internal hernia.

Bowel returned to abdomen. Haemostasis confirmed. Peritoneal irrigation with warm saline.

CLOSURE:
Mass closure with looped PDS / PPDS. Skin closed.

FINDINGS:
[Describe segment, length, mesentery, bowel viability]. Remaining bowel viable.

SPECIMEN: Small bowel segment to histopathology.
EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Nasogastric tube if prolonged ileus anticipated. Oral intake when bowel sounds return. VTE prophylaxis.