Laparoscopic small bowel resection and anastomosis

Our aim was to assess the feasibility and safety of performing totally intracorporeal laparoscopic small bowel resection and anastomosis using a linear stapling device. Laparoscopic small bowel resection and anastomosis were performed in five young domestic pigs. Five trocars were used (2n-5 mm, 2n-11 mm, and 1n-12 mm) for video laparoscopic access to the peritoneal cavity. Segments of jejunum 5 to 10 cm long were excised using two firings of a 30-mm linear stapler (Endo-GIA). The bowel was anastomosed with the stapler in a functional end-to-end fashion, and the enterotomy was stapled closed. The excised bowel segment was then placed in a nylon entrapment sack, morcellated, and aspirated with an automatic electrical tissue morcellator. The pigs recovered uneventfully, were allowed oral feedings on the day after the operation, and gained weight normally in the postoperative period. Sacrifice after 4 to 10 weeks revealed few adhesions, no evidence of anastomotic leaks, and the anastomoses to be widely patent. Clinical application will be facilitated by the use of longer laparoscopic staplers, but surgeons must also develop suturing skills to assure safe performance of advanced laparoscopic surgery.