A minimally invasive procedure is commonly used to treat diseases of gastrointestinal tract. Unlike traditional surgery of intestines where a long incision down the center of the abdomen is required, laparoscopic surgery requires only small "keyhole" incisions in the abdomen. The common conditions that may require surgery of small intestine are:
- Benign tumors
- Meckel's Diverticulum
Strictures are narrowing of a section of intestines, which causes problems by slowing or blocking the movement of food through that area. They are caused by recurrent inflammation and can hospitalize a person due to partial obstruction. Strictures can also cause intestinal obstruction further leading to perforation of bowel. This perforation can result in severe infection of abdominal cavity (peritonitis), abscesses (collections of infection and pus), and fistulae (tubular passageways originating from the bowel wall and connecting to other organs or the skin). In addition, strictures of small bowel can lead to bacterial overgrowth, which is another intestinal complication of Inflammatory Bowel Disease (IBD).
Causes and Symptoms of Strictures?
Strictures are formed primarily because of inflammatory bowel diseases like Tuberculosis, Ulcerative colitis and Crohns disease. They may also develop due to tumors, adhesions and radiation therapy. The common symptoms that can occur are:
- Crampy abdominal pain
- Inability to pass flatus or stools
How Are Strictures Diagnosed?
The below mentioned tests are used for diagnosis of strictures:
- Plain abdominal X-RAY, erect and supine
- CT Scan
Treatment Options for Strictures
There are two ways to perform the surgery:
Laparoscopic surgery: Two to three small incisions are made in the abdomen and laparoscope is used for performing the surgery.
Open surgery: A large surgical cut is made across the left or middle of the abdomen.
Laparoscopic Surgery for Strictures
- The surgeon makes two-three small incisions in the abdomen and inserts laparoscope and other surgical instruments through these incisions.
- The surgeon locates the stricture and treats it surgically.
- Compromised section of the intestine is removed and the healthy ends are rejoined with staples or stitches.
B. Benign Tumors
Tumors can be benign and malignant, however, some benign tumors can progress and become malignant. The tumors of small intestine are rare, they are usually single but can multiply particularly in certain syndromes (i.e intestinal polyposis syndrome). It is observed that most small intestines are clinically silent for long periods, which means that nealry 50% of all benign small intestine tumors are incidentally located either during an operation or investigation of small intestine for other reasons.
Different Types of Benign Tumors
The types of benign tumors include:
Leiomyoma: These are tumors are present in one of the muscle layers of bowel wall. Some tumors grow in the lumen of bowel and become ulcerated, causing bleeding and anemia. In case they grow in small intestine, it can be very difficult to diagnose them,so biopsy sampling and surgery is recommended.
Adenomas: They are benign tumors and cannot be malignant. If they arise in the region of papilla or duodenum, where bile ducts and pancreas drain, they can cause jaundice. Adenomas are usually removed by surgery or endoscopy because of the risk of malignant degeneration.
Lipomas: They are formed due to the accumulation of fatty tissues within the wall of intestine, and appear yellow in color when viewed endoscopically. These are completely benign tumors with no malignant potential.
Hemangiomas: When the blood vessels get collected, they form a benign vascular tumor in the wall of stomach or intestine. These tumors can cause gastrointestinal bleeding and anemia.
Neurogenic Tumors: They are formed due to an abnoraml growtth of nerve tissue. The most common type of Neurogenic tumors are Neurofibroma.
Laparoscopic Surgery for Benign Tumors
- Two-three tiny incisions are made in the abdomen
- The surgeon then enters laparoscope and other surgical instruments through these incisions.
- The surgeon locates the tumor and removes it.
C. Meckel’s Diverticulum
It is present as a pouch on the wall of lower part of small intestine. It is approximately 2 feet proximal to its junction with large intestine and is usually present at the time of birth (congenital). The diverticulum may contain tissues similar to that present in stomach or pancreas.
What are the Causes and Symptoms of Meckel’s diverticulum?
It occurs in the fetus during early pregnancy. The vitelline duct connects the growing fetus with the yolk sac and is absorbed into the fetus by 7th week of pregnancy. In case, the vitelline duct is not fully absorbed, a Meckel's diverticulum is formed. It may contain cells from pancreas and stomach. If stomach secretes acid, it can cause ulcers and bleeding. The common symptoms usually occur during the first year of child's life, and can reoccur in adulthood. They are:
- Gastrointestinal bleeding (which can be seen in the stool)
- Abdominal pain and cramping
- Tenderness near the navel (belly button)
- Obstruction of the bowels, a blockage that keeps the contents of the intestines from passing. This can cause pain, bloating, diarrhoea, constipation, and vomiting.
- Diverticulitis (swelling of the intestinal wall)
- Symptoms may mimic Acute Appendicitis
Laparoscopic Surgery for Meckel's Diverticulum
- Two to three tiny incisions are made in the abdomen and a laparoscope is inserted through one of the incisions which enables the surgeon to view the abdomen on a video monitor.
- Surgical instruments are inserted through the other incisions.
- The surgeon removes the Meckel's diverticulum along with the surrounding compromised portions of the small intestine. T
- The healthy ends of the remaining small intestine are joined back using staples or stitches.
Advantages of Laparoscopic Surgery
- Minimal postoperative pain
- Shorter hospital stay and quick return to work and normal activities.
- Excellent cosmetic results