Small bowel resection & anastomosis

Why are we operating?

Segmental removal of non-viable or diseased small bowel with restoration of continuity.

Indication: Ischemic, obstructed non-viable, perforated, or tumour-bearing small bowel.

The operation in 4 steps

1. 01Assessing viability

   Colour, peristalsis, mesenteric pulsation, and bleeding from cut edges judge which bowel lives.

   Why: Resecting too little leaves ischemic bowel to perforate; too much risks short-bowel physiology, the judgement IS the operation.

2. 02Resection

   Mesentery scored and vessels ligated in a V toward the specimen; bowel divided between clamps.

   Why: Taking the mesentery as a V preserves the arcade supply to the ends that will be joined.

3. 03Anastomosis

   The two ends are joined, hand-sewn in layers or stapled side-to-side.

   Why: An anastomosis needs three things: blood supply, no tension, and accurate apposition. Every technical choice serves one of those.

4. 04Closure

   Mesenteric defect closed, counts completed, abdomen closed in layers.

   Why: An open mesenteric defect is a ready-made internal hernia; closing it now prevents an obstruction later.

Anatomy you need

Turn the bowel and note how mesentery carries the blood supply; a resection is planned on those arcades.

What can go wrong

• Anastomotic leak

  Day 3–7: tachycardia, fever, abdominal pain, ileus that fails to resolve, or subtle deterioration that 'doesn't add up'.

• Postoperative ileus

  Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.