Surgery on the small intestine is used to treat small intestinal obstruction, growths, inflammation, tumours or circulatory disorders of the small intestine. A part of the small intestine is often removed (segment resection). Moreover, a temporary or permanent stoma is required sometimes.

The small intestine consists of three sections: Duodenum, illeum and jejunum. Surgery and procedures on the duodenum are described in the chapter entitled [duodenum surgery]. The most common reasons for surgery on the illeum and on the jejunum are inflammations (Morbus Crohn), colonic obstructions due to growths or tumours as well as small intestinal haemorrhaging or circulatory disorders of the small intestine. It is usually sufficient to remove the part of the small intestine affected by the disease (segment resection). However, an external stoma through the abdominal wall is sometimes also required.

What preparations are carried out before the procedure?

Different examinations such as ultrasound, CT or enteroscopy are carried out to make an exact diagnosis. All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG.

All blood-thinning medication must be discontinued before the procedure takes place. Duodenal surgery is performed under general anaesthetic. Patients must have an empty stomach for the procedure.

How is the operation performed?

Both the partial removal of the small intestine (segment resection) as well as the attachment of a stoma are usually carried out with minimally invasive keyhole surgery (laparoscopy).

Segment resection of the small intestine

In the case of the minimally invasive procedure with the laparoscope, a camera and surgical instruments are inserted through the abdominal wall with the laparoscope. The part of the small intestine affected by the disease is then exposed, resected and removed. Then, the two ends on either side of where the section of small intestine was resected are connected with a suture (small intestine anastomosis).

Stoma

An artificial small intestine outlet (small intestine stoma) may need to be attached for different reasons. Sometimes the remaining small intestine must be temporarily rested. For this reason, a temporary small intestine stoma must be attached to rest the colon. However, in some cases, the ends of the intestines can no longer be connected with one another after the small intestine has been removed. In such a situation, a permanent stoma is unavoidable.

If a small intestine stoma is attached, the ends of the small intestine are drawn through the abdominal wall and fixed to the skin. An opening (stoma) is formed from the colon ends, and the stoma bag is attached to this. The bag captures the liquid faeces, and must be regularly changed.

What is the success rate of this procedure?

The success rate of the procedure depends on the underlying disease. If the colon is obstructed due to growths or benign tumours, partial resections offer good prospects of recovery. Obstructions or fistula formation in patients with Morbus Crohn can be remedied with a procedure; however, the underlying disease cannot be healed.

What are the possible complications and risks of this procedure?

As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections. Sometimes the colon connection (anastomosis) does not work as it should and further surgery is required to deal with this malfunction.

In rare cases, it can lead to circulatory disorder in the stoma, abscesses or to a retraction of the stoma under the skin.

What happens after the operation?

After the surgery, the patient wakes up in the recovery room. The drainage tubes are usually removed in one or two days. The patient's food intake is carefully increased on a step by step basis. Patients who undergo this operation must usually stay in hospital for three to five days. They should avoid major physical exertion for six to eight weeks after the operation.

The healing process is monitored with regular follow-up examinations. Stoma wearers are taught how to deal with the stoma and care for it. At the beginning, four to five litres of fluid can be excreted via the stoma per day. During this time, patients need to ensure that they are drinking enough water. Sometimes an infusion is also required and the fluid excretion must be reduced with medication. Over time, the fluid excretion over the stoma should reduce to 1/2 to 1 litre per day.  After a certain adjustment period, you can usually resume your daily activities, sport and leisure activities without any restrictions. When the fluid loss has reduced to a normal amount, the patient can eat and drink again as usual.

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