Large quantity of liquids and nutrients from food are absorbed by small intestine which is a part of the human digestive system. Small intestine consists of three segments: they are the jejunum, the duodenum, and the ileum. The ileum is followed by the sigmoid colon. When small intestine is inflicted with diseases like ulcers, Crohn’s disease etc or when they are injured or when the bowel is partially or completely blocked or when precancerous polyps are grown in them, the resection of bowel is necessitated.
Preparation for surgery
Just like any other surgery the patient will be required to sign a consent letter. The details of the procedure will be explained by the surgeon. Blood, urine tests and various imaging techniques will be done if required. The patient will be asked to completely clean the stomach and be on a residuary diet for a few days prior to the surgery. A liquid diet will be given on the previous day of the surgery and the patient is expected not to eat or drink anything after the midnight. Mechanical cleansing of the bowel and use of antibiotics to decrease the presence of bacteria in the intestine are commonly practised. A nasogastric tube will be inserted on the day of surgery through nose to the stomach which will remove the gastric secretions and prevent vomiting and nausea. A catheter will be inserted to the bladder for emptying the urine during the surgery.
Laparoscopic bowel resection
A small telescope like instrument called laparoscope is inserted through a small incision made near the umbilicus. This laparoscope is connected to a video monitor placed in front of the surgeon in the operation theatre. Carbon dioxide is filled in the abdomen to inflate it and give a clear view of the operating area to the surgeon. Additional four small incisions are made in the abdomen through which special miniature instruments used for carrying out the surgery are inserted. The surgeon carries out the surgery viewing the videos taken by the laparoscope in the operation theatre. The surgeon clamps the upper and lower portion of the affected section of the small intestine and removes this section. The ends of the cut small intestine are joined together by sutures or staples. After completing the surgical procedure, the small incisions made for the laparoscope and other instruments are closed with surgical tapes or sutures.
After completing the surgical procedure, the patient will be removed to recovery room where he will be under the nursing care of a qualified nurse. Pain medication will be prescribed by the physician as mild pain will be experienced by the patient during this period. The patient may feel some difficulty in breathing because of the anaesthesia and will be instructed to support the operative area during coughing. The nasogastric tube will be active until the bowel activity resumes. Fluid and nourishments are given through intravenous tube till the patient’s diet is gradually resumed. Patient will need nursing attention for up to 24 hours after the surgery. The patient will be scheduled for a follow up examination after two weeks of the surgery. Physical activity of the patient will be restricted for a few days after the surgery.
Peculiarities of laparoscopic surgery
- As the incisions are smaller there will be less pain and the healing will be faster.
- The recovery to normalcy and routine works will be quicker.
- This method is not suitable for patients who are obese and diabetic.
- It is not possible to carry out laparoscopic procedure if the patient has already been subjected to a surgical procedure in the target area.