FLS Practice Exam 2026 – Complete Guide to Laparoscopic Surgery Preparation

The main idea is to begin the bowel survey at a reliable anatomical landmark that marks the boundary between the small and large intestine. The ileocecal valve sits at the junction of the ileum and cecum, so it provides a clear, consistent starting point to trace the small bowel. From this valve you can move proximally to locate the level of obstruction and distally to assess the rest of the bowel, distinguishing dilated small-bowel loops from the collapsed distal bowel. This orientation helps determine the exact location of the obstruction and evaluate the surrounding segments.

Starting at the appendix or the cecum isn’t as useful for this survey because they’re parts of the large bowel and don’t give a reliable, systematic route through the small bowel. Beginning at the duodenum is too proximal to efficiently survey the entire small bowel for a transition point.