Chapter 11: Table of Contents
- 11.1 Intestinal Biopsy
- 11.2 Intestinal Biopsy Quiz
- 11.3 Intestinal Resection and Anastomosis
- Intestinal Apposition and Closure
- Suture the mesenteric rent, leak test, and omentalize
- Video: Intestinal Resection and Anastomosis
- How to accommodate discrepancies in luminal size when performing a resection-anastomosis
- Decision-making in the management of gastrointestinal foreign bodies
- Decision-making in the management of gastrointestinal foreign bodies: continued
- Decision-making in the management of gastrointestinal foreign bodies continued
- Enterotomy vs. Resection-Anastomosis
- Assessing Intestinal Viability
- Where to incise when removing a focal foreign body via enterotomy?
- Linear foreign body removal
- Where to cut when performing a resection-anastomosis
- Prognosis- foreign body
- Use of Antibiotics?
Intestinal Resection and Anastamosis
Identify the area to be resected (refer to section on management of foreign bodies below). Determine which vessels will require ligation. Double ligate the appropriate mesenteric arcadial and end arcadial vessels. Then transect all vessels leaving sufficient mesentery for closure.
Cut the bowel ends at an angle (longer on the mesenteric border than on the antimesenteric border) to ensure good blood supply to the anastomotic site. If the tissues at the cut end don’t look healthy, remove more. In an ideal world, all of the grossly abnormal intestine should be removed. This becomes difficult in cases with extensive intestinal trauma caused by linear foreign bodies since resection of 70-80% of the small intestinal length or more results in short-bowel syndrome. Because short bowel syndrome leads to severe diarrhea, bacterial overgrowth and weight loss, the surgeon must, in some cases, cut the intestine in a less than ideal location to allow for enough intestinal length to remain; this obviously increases the risk of postoperative dehiscence.