Perioperative management - Jejunal segment resection with side-to-side anastomosis

• Small bowel stenosis due to tumor or extensive scar stenosis.
• In severe dissection-related injuries of the small intestine that cannot be managed by oversewing and therefore require a small bowel resection.
• For exclusion of a small intestine segment for an ileal conduit for urinary diversion and restoration of continuity.
• After small bowel resections due to ischemia.
• In small bowel resections due to involvement in a tumor located elsewhere or similar.

• Even after small bowel segment resections, an anastomosis can be critical with regard to healing: e.g., in very difficult perfusion conditions or the most severe comorbidity of the patient, such as septic shock.
• In these cases, a stoma creation should be considered and possibly more sensible, in order not to risk an anastomotic insufficiency!

• For tumors, cross-sectional imaging with computed tomography or MRI is indicated.
• For chronic inflammatory bowel diseases, small bowel imaging using MRI-Sellink is the optimal standard today.
• In exceptional cases, a simple contrast medium representation using a water-soluble contrast medium can be performed (relatively inaccurate examination, in ileus the contrast medium dams up before a stenosis without leading to a meaningful statement).
• in individual cases, double-balloon endoscopy or capsule endoscopy can be performed, particularly to clarify endoluminal findings.

• A special preoperative therapy or preparation is not necessary:
• In general, it is sufficient to keep the patient fasting overnight, as the small intestine empties within the shortest time.
• A lavage with saline or other laxatives is common, but according to recent data, not useful!

• General surgical risks

In addition:

1. Risk of anastomotic insufficiency.
2. After extensive small bowel resections – particularly in the terminal ileum – attention should be drawn to the possibility that permanent substitution of vitamin B12, fat-soluble vitamins, and calcium may become necessary!
3. For planned extensive resections, note the possibility of short bowel syndrome!