A midline incision is made, usually extending around the umbilicus. The abdomen is entered and explored. As previously stated, in the majority of cases, small bowel disease associated with pelvic disorders is located within 3 feet of the ileocecal bowel. This fact is of significant value to the pelvic surgeon in that it allows the surgeon to trace the small bowel back from the cecum rather than trace the bowel down from the ligament of Treitz.
At this point, the decision must be made to perform either a small bowel resection or small bowel bypass. If the limits of the small bowel disease are identifiable and can be mobilized without extensive dissection, small bowel resection is the procedure of choice. If, however, as in the majority of cases, the diseased segment of small bowel is embedded deep in the true pelvis, particularly after heavy pelvic irradiation, it is wiser to perform a small bowel bypass.
A midline incision is made, usually extending around the umbilicus. The abdomen is entered and explored. As previously stated, in the majority of cases, small bowel disease associated with pelvic disorders is located within 3 feet of the ileocecal bowel. This fact is of significant value to the pelvic surgeon in that it allows the surgeon to trace the small bowel back from the cecum rather than trace the bowel down from the ligament of Treitz.At this point, the decision must be made to perform either a small bowel resection or small bowel bypass. If the limits of the small bowel disease are identifiable and can be mobilized without extensive dissection, small bowel resection is the procedure of choice. If, however, as in the majority of cases, the diseased segment of small bowel is embedded deep in the true pelvis, particularly after heavy pelvic irradiation, it is wiser to perform a small bowel bypass.
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