Small bowel procedures

The entire small intestine receives its blood supply from the superior mesenteric artery through a complex arcade of anastomosing branches that provide a rich blood supply to the organ. Limited traumatic intraoperative injuries to the small bowel can usually be successfully repaired using a primary closure technique that preserves blood supply, luminal integrity, and diameter. Resection and reanastomosis should be considered for more extensive injuries or in damaged bowel segments that involve prior irradiation, chronic inflammation, tumors, or fistulae. In the absence of perforation or peritonitis, reanastomosis can be performed at the time of resection without diversion. Although handsewn and stapled techniques for small bowel anastomosis provide acceptable results, we favor the use of gastrointestinal staplers because of their ease of use, ability to preserve blood supply, and development of an excellent internal lumen. With appropriate attention to operative technique and postoperative management, virtually all patients with small bowel anastomosis are able to achieve recovery of intestinal function.