Jejunal segment resection with side-to-side anastomosis

Small median laparotomy, depending on the location of the findings in the small intestine above the umbilicus, periumbilical or below the umbilicus.
It should be noted that laparotomies in the lower abdomen leave a cosmetically better result. The skin incision should be started with a length of about 8 cm. Through this, the small intestine can usually be adequately exteriorized and, if necessary, the skin incision can then be extended. As a rule, a left-sided circumincision of the umbilicus, if required, is common.

When an anastomosis is performed, it is advisable to protect the skin edges by folding them over with a foil or a moist abdominal cloth and then to insert a retractor.

The small intestine is eviscerated and the finding is located. Whenever possible, the entire small intestine should be inspected, which, provided no adhesions are present, is usually possible through a correspondingly small surgical access.

Subsequently, the resection boundaries are defined, e.g., by encircling with a rubber loop, which significantly facilitates visibility.

Subsequently, the mesentery is gradually transected over Overholt clamps. Distally, towards the specimen, ligatures are applied. Centrally, the mesentery is secured with ligatures or sutures. Centrally, care must be taken to ensure that secure hemostasis is achieved here, so in case of doubt, it is better to use one more suture than one too few.

Especially if there is a lumen difference, as in the present case, it is advisable to perform a side-to-side anastomosis. In the present patient, in addition to extensive metastasis due to prostate carcinoma, stenosis caused by a primary small intestine carcinoma has occurred, which is clearly recognizable by the dilated proximal bowel loop. Due to the palliative situation with an already infaust prognosis, only a segment resection is performed. If a primary carcinoma were present, which is operated on with curative intent, the resection margins should be chosen wider and the mesentery together with the lymph nodes should be removed far centrally. As preparation for the side-to-side anastomosis, the bowel ends are stapled. For cost reasons, a simple oversewing of the bowel ends can also be performed.

The bowel ends can, but do not have to be, oversewn in the area of the staple line. The advantage of oversewing is that hemostasis is definitely present there and adhesions with other parts in the abdominal area, such as to the bowel loops with the staple line, can be avoided.