expert in robotic small bowel surgery

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The small bowel measures up to 25 feet in length. It can be difficult to locate or identify problems that need surgical correction, but the advanced capabilities of robotic surgery decreases the need to perform small bowel surgery with large incisions.

Summary

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  • The small bowel is the primary organ for nutrient absorption and digestion. A number of small bowel problems that require surgery may actually stem from childhood or development in the womb, but not present until adulthood.

    • Obstruction (blockage)

    • Volvulus (twisting)

    • Cancer

    • Diverticula (“bubbles”)

    • Meckel’s Diverticulum (congenital “bubble” that can cause inflammation or mimic appendicitis)

    • Crohn’s disease

    • Ischemia (low blood flow)

    • Malrotation (bowels are in the wrong place due to abnormal development)

    • Fistula (abnormal connection between 2 organs or even skin)

    • Perforation (tear in the bowel)

    • Intussusception (“telescoping” of the bowel into itself")

    • Arteriovenous malformations (causes GI bleeding)

    • Annular pancreas (pancreas wraps around the bowel, causing obstruction)

  • Symptoms of a small bowel problem are dependent on the disease, but will usually present with abdominal pain, nausea, vomiting, bloody bowel movements, food fear and possible weight loss, malnutrition, or inability to pass gas (in obstruction).

  • Diagnostic testing will depend on the presumed diagnosis, but can include CT scans, small bowel follow through (a drink that makes the small bowel visible on X-ray), and even endoscopy by a trained gastroenterologist.

  • Depending on the disease being treated, surgery can range from placing the bowels in the correct area in the abdomen (as in the treatment for malrotation), or removal of a diseased section of small bowel with reconnection.

Small Bowel

The small bowel, or small intestine, is a vital organ responsible for the majority of nutrient absorption and digestion. It consists of three sections—the duodenum, jejunum, and ileum—each playing a unique role in breaking down food and extracting essential vitamins, minerals, and macronutrients. The small intestine’s vast surface area, created by folds, villi, and microvilli, allows for efficient absorption while also serving as a barrier against harmful substances. It coordinates with the pancreas, liver, and gallbladder to process fats, proteins, and carbohydrates. Disorders affecting the small bowel, such as malabsorption syndromes, motility disorders, strictures, cancers, or obstructions, can lead to significant nutritional deficiencies and digestive complications, often requiring specialized evaluation and treatment.

Because of it’s length of approximately 25 feet in the human adult, the small bowel can be affected by many issues, and minimally invasive surgery can be technically challenging in the limited abdominal space. In the right hands, however, even complicated small bowel surgery is successful when done robotically, improving recovery and decreasing the time spent in the hospital recovering.

Small bowel obstruction (SBO) occurs when the normal flow of digestive contents is blocked, preventing food, fluids, and gas from passing through the intestines. Common causes include surgical adhesions, hernias, tumors, inflammatory bowel disease, and strictures. Symptoms often include severe abdominal pain, bloating, nausea, vomiting, and inability to pass gas or stool. If left untreated, an obstruction can lead to bowel ischemia, perforation, or infection, making early diagnosis critical. Treatment depends on the severity—partial obstructions may resolve with bowel rest and fluid management, while complete obstructions or those causing complications often require surgical intervention to remove the blockage and restore normal function.

Small bowel ischemia occurs when blood flow to the small intestine is reduced or completely blocked, leading to tissue damage and, if untreated, potential bowel death (necrosis). This can be caused by arterial embolism or thrombosis, venous clotting, prolonged high-grade severe obstruction, or low blood flow states (non-occlusive ischemia) due to conditions like heart failure or shock. Symptoms can include sudden, severe abdominal pain, nausea, vomiting, diarrhea, and, in later stages, bloody stools and peritonitis. Small bowel ischemia is a surgical emergency, requiring prompt intervention to restore blood flow and remove any non-viable bowel. Early recognition and treatment are critical, as delayed care can result in life-threatening complications and the need for extensive bowel resection.

Intestinal malrotation is a congenital condition where the intestines do not rotate properly during fetal development, leading to abnormal positioning and a risk of life-threatening complications like volvulus (twisting of the bowel), which can cut off blood supply and cause ischemia. Symptoms vary but may include bilious vomiting, severe abdominal pain, bloating, and feeding difficulties, often presenting in infancy but sometimes remaining undiagnosed until later in life. Surgical treatment, typically the Ladd procedure, involves untwisting any volvulus, dividing abnormal bands (Ladd’s bands) that obstruct the duodenum, widening the mesentery to prevent future twisting, and repositioning the intestines in a safer orientation. Early surgical intervention is critical to prevent bowel loss and restore normal digestive function. Dr. Le is one of only a few surgeons in the United States performing this surgery robotically in adults.

Robotic small bowel surgery

Because of the length of the small bowel (approximately 25 feet in the human adult), minimally invasive surgery for this organ can be technically challenging, which will often lead to larger incisions. Larger incisions are associated with higher levels of postoperative pain as well as increased risk of incisional hernias, requiring surgery to repair down the road. Because of Dr. Le’s expertise in robotic surgery, non-emergent, and even many emergent types of small bowel surgery can be done with small incisions, improving your post-operative pain, lowering your risk of incisional hernia development, and minimizing your length of hospitalization post-surgery.

Before Surgery

  • You will be seen by Dr. Le in the clinic for a comprehensive history and physical, and to discuss your symptoms specific to your problem.

  • Testing for small bowel problems can be extensive depending on symptoms, but include upper endoscopy, small bowel x-ray studies, and CT scans.

  • Follow up visit or telehealth visit to discuss results of testing if needed.

  • Smoking cessation for 2 weeks before and 2 weeks after surgery to lower anesthetic risks.

  • Prepare for surgery.

After Surgery

  • Most of the time, you will be admitted overnight for monitoring, but this depends on the surgery you’ve had.

  • No heavy lifting more then 30 lbs for 2-3 weeks, with a slow and steady increase back to normal activity over 2 weeks after that.

  • You will be permitted to shower 24 hours after your surgery, patting dry the areas of your incisions.

  • A soft mushy diet, free from meat, chewy breads, and carbonated beverages for 1-2 weeks after surgery will be recommended.

  • You will be scheduled for at least one followup visit about 1 week after your operation.

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