*7.7.4 Small intestine*

If gastrectomy and total colectomy were done previously with good hemostasis of the vessels, removal of the small intestine is relatively easy and straight forward. As I told before, at the start of the operation for exposure of the aorta and IVC, small intestine is gently wrapped in a lap-sponge and pull cephalad to detach all the mesentery in an avascular plain from ileum to the Treitz. At the end of operation and evacuation of all the blood by aortic and IMV irrigation, the small intestine only attached to the body superior mesenteric pedicle containing SMA and SMV. Duodenojejunal and ileojejunal junction was previously cut by staples and the whole graft can be removed only by cutting the SMA and SMV at this time. If small intestine is decided to transplant separately, it is necessary to remove it before liver and pancreas but if a multivisceral transplant is planned for the recipient, any dissection around the SMV and SMA at the root of mesentery is forbidden and IMV should be used for cannulation of the portal vein [30, 32, 33].
