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Minimally Invasive Surgery - Surgery of the small intestine

Patients can sometimes require the placement of a feeding tube in the beginning part of the small intestine to receive nutrition. This is particularly true if the stomach cannot be used or if there is a high risk of choking when the stomach has been used in the past.

The tube is placed using a laparoscopic approach with only 4 small incisions, one of which is used for the tube itself. The tube is secured to the small intestine using stitches, then that part of the intestine is secured to the abdominal wall (show pictures). During the operation, the tube is tested to ensure it does not leak where it enters the intestine. The day after surgery, a special x-ray is taken to confirm this and feedings are begun. Depending on the situation, it is possible for the patient to go home once the appropriate amount of feedings is being taken in.

Scar tissue can develop after any surgery of the abdomen as part of the natural healing process of the body. The degree to which this happens depends on many factors, such as whether the prior surgery was an emergency, involved infection and whether or not it was done laparoscopically. Scar tissue can cause intermittent blockage of the intestines as they can kink (much like a garden hose) and this results in nausea, vomiting, severe bloating and inability to eat or drink. In certain patients, there may be a benefit to cutting the scar tissue to relieve this problem if it is recurring frequently. This procedure, called a lysis of adhesions (cutting of scar tissue and freeing the intestine) is best performed laparoscopically to minimize the return of more scar tissue, when feasible. This can be done with several ¼ inch incisions. Patients often return home within 2 – 3 days depending on the specific situation.

Benign tumors of the small intestine exist that can sometimes cause problems such as kinking and partial blockage. Patients may notice nausea or bloating. However, there are times when there are no symptoms and they are found on endoscopy. Patients with these tumors are then evaluated to see if they have spread or not. If they have not, then an operation to remove them can be performed. Surgical removal of tumors of the small intestine can be performed laparoscopically. A certain amount of intestine must be removed on either side, depending on if it is benign or malignant (cancer). Once this is done, the intestines are reconnected and the portion to be removed can be brought out through a small 2 inch incision. This is much smaller than the 8 – 10 inch incision needed to perform the same operation in conventional surgery. Patients can expect to go home once their intestines start working again—typically in 2 – 3 days. With this approach, there is less pain and the time it takes for the intestines to work again is less than when the conventional approach is used.

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