A friend recently had a few inches of tumorous bowel removed, after which the healthy portions of bowel upstream and downstream of this section were spliced back together.
Made me wonder…it seems like infectious material is guaranteed to leak out of the bowel through the stitches. So how do they prevent infection of the abdomen while this bowel-to-bowel joint knits together and eventually forms a good seal?
"Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. "
When there is high risk of infection (i.e. ruptured diverticulitis, abscess etc.) doing a colostomy may reduce that risk.
What do bowel surgeons, walruses, and plumbers have in common?
They all like a good tight seal
If the surgeon did the procedure correctly, the join between bowel segments does not leak.
Lots of antibiotics…Seriously. There is a well thought-out leak preventative process but bowel surgery is considered non-sterile surgery. But…the moist tissue tends to be self sealing and hard, solid food is withheld for a few days. Unless this was a much older or very experienced surgeon they probably used a circular stapler which was initially developed in Russia after WWII when there was a shortage of good surgeons. The stitches or staples DO provide adequate mechanical attachment of the two halves before healing starts.
There are Youtube videos. Search for “end/end anastomosis” or “circular stapler”.
For a cite as to my credibility, I’m named on this patentand I’ve observed this surgery.
Lots of antibiotics…Very seriously.
I had a torn colon and peritonitis and emergency surgery and a week in the hospital three years ago. They had me on some IV antibiotic that made me smell like scrambled eggs, taste scrambled eggs, and begin to think of myself as being made of scrambled eggs. I sweated essence of scrambled eggs for days.
To elaborate further, the quickest and most automated approach (which can done endoscopically - much quicker recovery, much more difficult and poorer visualization for the surgeon) goes as follows. First, many bowel cancers occur in the large intestine which is mostly attached to the body wall. It first must be “mobilized” or cut away from the body wall and a plan for how much to remove is thought out. Then a Linear Cutter instrument is clamped across the bowel and fired. This places two rows of staples and simultaneously cuts the bowel between the two rows, leaving both ends sealed. This is done twice and the diseased sealed bowel is taken away but the cut ends can STILL ooze microbes and they WILL get brushed against surrounding organs. There is then a process by which the 2 halves of the Circular Stapler are assembled into the two loose ends, the joint (anastomosis) is pulled together, and the stapler is fired, producing a ring of staples and cleanly cutting a round hole inside the staple line with the edges of the bowel being inverted so no fecal tissue touches the body cavity. The stapler is then withdrawn through the anus. The linear cutter is not absolutely necessary and there are other anastomosis techniques but the circular stapler is pretty common and a very handy device.
Yowza! That’s quite a thing to accomplish via remote control insiode the squishy innards of a live person.
Is any of that endoscopic technique relevant to resection of the small bowel? Or is that still pretty much limited to
Instrumentation to do endoscopic bowel resections for certain cases was available in the early 1990’s. I’m not sure of the current thought. Endoscopy would only be used for a known specific problem with an established procedure. It does dramatically improve patient recovery time which reduces cost.
Endo retrieval bags for laparoscopic cholecystectomies are routine in many systems now; not all surgeons are convinced they actually help, but many/most do use them.
Tag-on question, but couldn’t you use something like superglue or some other adhesive to make sure that there was a complete seal?
Tissue adhesion is a very tricky nut to crack - and most research has focused on the much more dimensionally-stable, structurally less complex dermal/epidermal surfaces. As a rule, “sealants” in surgical use are only effective when they boost a preexisting system (e.g. collagen matrices for enhancing coagulation) rather than a de novo one.
that’s not something you hear everyday…
And despite all the precauutions, bowel surgery is one of the riskier procedures with regards to infection risk.
On a brighter note 
…we did some gynecological endosurgery training using goats because of physiological simularties…wait…
So…goats are ruminants…so they produce a lot of methane gas…and we pumped them up with air…and used electrosurgery which can produce sparks…and sometimes internal organs get nicked accidently…
Us engineers joked about when would we have the first surgeon “blow a goat”?? 