Definition & Overview
An enterectomy is a surgical procedure used to remove a portion of the intestine. It can be performed alone for the treatment of small bowel conditions but is often combined with other gastrointestinal procedures as well as reconstructive surgery to replace some parts of the gastrointestinal or urologic tract. The procedure, which is performed through either open or laparoscopic surgery, becomes necessary when a part of the patient’s intestines become damaged or diseased. Performed while the patient is under general anaesthesia, the procedure ends with the surgeon repairing the intestine to make it function as normal.
Who Should Undergo and Expected Results
An enterectomy is the surgical resection of the small bowel. It is performed in patients who suffer from small bowel conditions, or when a part of the small intestine becomes damaged or diseased.
Small bowel conditions include:
- Small bowel obstruction
- Small bowel neoplasm
- Small bowel inflammatory disease, such as Crohn’s disease
- Small bowel herniation with vascular compromise
- Celiac disease
- Irritable bowel syndrome
- Peptic ulcer
- Intestinal cancer
- Enterocutaneous fistula
- Mesenteric tumours
- Small bowel ischemia, usually associated with a small bowel obstruction or a hernia
- Injury to the small bowel caused by trauma
- Ulcerative colitis
These disorders can cause various gastrointestinal symptoms, such as:
- Abdominal pain
- Excess gas
An enterectomy is an effective way to resolve various small intestine disorders because it removes the damaged or diseased part of the bowel that is causing the problem. However, it results in a shorter bowel, which can have several consequences for the patient, hence the need for other procedures such as an ileostomy.
An enterectomy is not without risks, but in some cases, it is the only effective treatment option that can bring long-term results. Despite its risks, it remains one of the most commonly performed abdominal surgeries due to its good historical track record dating all the way back to the 1950s.
How is the Procedure Performed?
An enterectomy is performed under general anaesthesia either through open or laparoscopic surgery. Prior to the procedure, the doctor performs several diagnostic tests to identify all diseased parts of the small bowel. This is important because unless all diseased parts are excised, there is a huge possibility that the patient may require another procedure in the future.
In open surgery, the surgeon makes a 6-inch long cut in the middle of the patient’s stomach. In laparoscopic surgery, 3 to 5 smaller cuts in the lower abdominal region are made where the laparoscope and other medical instruments are inserted. The surgeon will first evaluate the small bowel to identify the transection sites. In some cases, the surgeon may need to insert a finger inside the patient’s belly to remove the damaged or diseased part of the intestine. This is performed through an additional 2-3 inch incision.
After removing the diseased or damaged part of the intestine, the intestine is repaired by sewing or stapling its two healthy ends together. If there is not enough healthy portion of the intestine remains, the surgeon will create a stoma or an opening through the abdominal wall where the small intestine is connected. This may be permanent or short-term. This procedure is called an ileostomy, which is often combined with an enterectomy.
Possible Risks and Complications
Thanks to the development of minimally invasive surgery, an enterectomy is now a relatively safe procedure with minimal risk of blood loss, post-procedural pain, and infection. Nevertheless, it can still put a patient at risk of:
- Breathing difficulties
- Heart attack
- An incisional hernia or when tissue bulges through the incision
- Damage to nearby organs
- Ileostomy issues
- Scar tissue, which may cause intestinal blockage
- Anastomotic leak, or when the sewn ends of the intestines break apart after surgery. Studies show that anastomotic leaks occur in 1 to 8% of patients who underwent the procedure.
- Wound dehiscence
- Wound contamination
- Bowel obstruction, which more commonly occurs when the procedure is performed through conventional laparotomy. It is associated with adhesions, which cause between 3 and 30% of all cases of small bowel obstruction. Studies show that the risk of bowel obstruction is around 0.7% during the 4-week mark following the surgery, with 30% of cases occurring within a month of the procedure. In such cases, another procedure is needed to repair the problem.
There are some concerns regarding the effects of the procedure on the function of the intestines. This is known as short bowel syndrome, which occurs when a large amount of the small intestine needs to be removed. This may hinder the patient from absorbing key vitamins and nutrients from food as well as cause some changes in the way amino acids are transported.
Complications may cause symptoms such as lack of bowel activity and progressive distention.
The patient also faces the risks common to all surgical procedures. These include:
- Blood clot or haematoma
- Pain and discomfort after surgery
Surgeons suggest covering the surgical wound with a moist towel to prevent enteric contents from contaminating the edges of the wound. Surgeons have also begun using adhesion-prevention products to decrease the risk of bowel obstruction following the procedure.
Falcone RA, Shin CE, Erwin CR, Warner BW. “The adaptive intestinal response to massive enterectomy is preserved in c-srs-deficient mice.” Journal of Pediatric Surgery. 1999 May. 34(5): 800-804. http://www.jpedsurg.org/article/S0022-3468(99)90376-7/abstract
Huerta S, Kukreja S, Carter K, Butler D. “No gut syndrome: Near total enterectomy.” Journal of Gastrointestinal Surgery. 2015 May. 19(5): 973-980. http://link.springer.com/article/10.1007/s11605-015-2787-2