Laparoscopic enterectomy

A laparoscopy (keyhole surgery) enterectomy is a minimally invasive procedure requiring a general anaesthetic. The procedure is undertaken in order to remove part of the small bowel which is diseased. The most common reason is scar tissue causing intestinal obstruction, benign lesions such as polyps or fatty tissue that can cause pain as the intestine moves over them (intussusception) and cancers of the small bowel. Sometimes narrowing of the intestine because of inflammation which can occur in Crohn’s disease (inflammatory bowel disease) or due to poor blood supply can cause symptoms of pain and incomplete blockage of the bowel.

The procedure takes place through small incisions on your abdomen, 0.5-1cm typical size, through which gas is inflated in order to create space and make internal organs easy to see. A tiny camera (laparoscope) is then inserted into the abdomen guiding the insertion of further specialised laparoscopic instruments which are used to inspect the small bowel. Once the diseased part is identified part of the bowel is removed and the rest is joined together. The removed part of the bowel is then sent to be tested under a microscope to identify the cause of the problem.  Sometimes a temporary stoma may be formed if the bowel ends are not healthy or you are not very well during the operation (usually in the emergency setting). The stoma may then be joined back together at some time after the initial operation in order to restore bowel continuity. Your doctor will discuss the likelihood of this with you prior to surgery as well as the risk of conversion to open surgery.

Benefits of diagnostic laparoscopy

The benefit of a laparoscopic procedure compared to an open laparotomy, is that patients have less discomfort following the procedure and return back to normal activities much faster. There is a reduced risk of bleeding and wound infections, as well as less scarring inside the abdomen with the subsequent risk of bowel obstruction, while the smaller abdominal scars offer a better cosmetic result.

Recovery

After the procedure you will be taken to the recovery room. The enhanced recovery programme (ERP) is usually followed. You will need to spend a few nights in hospital. Open surgery requires a longer length of stay in hospital. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided. It normally takes a few weeks to fully recover from bowel surgery and return back to work but it varies from person to person and will depends on your general health and the nature of your work. You should avoid any heavy object lifting or strenuous exercise for at least 6 weeks to reduce the risk of a hernia developing.

Once the removed specimen, with the lymph nodes in the case of cancer, has been tested under a microscope your doctor will see you in clinic and discuss further management of your condition.

Risks of the procedure

The likelihood of some of the risks involved in bowel surgery depends on the type of the surgery performed, the disease involved and the health of the individual. Laparoscopic bowel surgery performed by an experienced laparoscopic surgeon has a similar if not better rate of complications compared to an open procedure. In terms of cancer surgery it is oncologically equal. The risks include complications common to all surgical procedures such as infection, bleeding, blood clots, heart problems, pneumonia, urinary retention, development of hernia and anaesthetic risks.

Complications specific to this operation include the risk of the bowel going into strike for a few days (ileus) and rare but significant risks such as leakage from the bowel joint, collection of fluid/pus inside the abdomen, damage to other organs inside the abdomen and a risk to your life. Some patients may experience some change in their stool consistency following removal of part of their bowel which usually improves with time. All of the above risks are less when performed by experienced surgeons and should be balanced against the risks of not undergoing surgery and the consequences of that. All the relevant information will be discussed with you at an individual basis prior to your surgery.