Small bowel resection
DefinitionSmall bowel resection is surgery to remove part or all of your small bowel. It is done when part of your small bowel is blocked or diseased.The small bowel is also called the small intestine. Most digestion (breaking down and absorbing nutrients) of the food you eat takes place in the small intestine.Alternative NamesSmall intestine surgery; Bowel resection – small intestine; Resection of part of the small intestine; EnterectomyDescriptionYou will receive general anesthesia at the time of your surgery. This will make you asleep and pain-free.If you have laparoscopic surgery:You will have three to five small cuts in your lower belly. The surgeon will pass a camera and medical instruments through these cuts.You may also have a cut of about 2 to 3 inches if your surgeon needs to put a hand inside your belly to feel the intestine or remove the diseased segment.Your belly will be filled with gas to expand it. This makes it easy for the surgeon to see and work.If you have open surgery, you will probably have a cut about 6 inches long in your mid-belly.Your surgeon will locate the part of your small intestine that is diseased.Then your surgeon will put clamps on both ends of this part to close it off.The surgeon will remove the diseased part.In both kinds of surgery:If there is enough healthy small intestine left, your surgeon will sew or staple the healthy ends of the small intestine back together. Most patients have this done.If you do not have enough healthy small intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. Your small intestine will be attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called an ileostomy. The ileostomy may be either short-term or permanent.Your surgeon may also look at lymph nodes and other organs in your belly area. Before surgery, the surgeon will talk with you about the possible need to remove other organs.advertisementThis surgery usually takes 1 to 4 hours.Why the Procedure Is PerformedSmall bowel resection may be recommended for:A blockage in the intestine caused by scar tissue or congenital (from birth) deformitiesBleeding, infection, or ulcers caused by inflammation of the small intestine. Three conditions that may cause inflammation are regional ileitis, regional enteritis, and Crohns disease.CancerCarcinoid tumorInjuries to the small intestineMeckels diverticulumNoncancerous (benign) tumorsPrecancerous polyps (nodes)RisksRisks for any surgery are:Blood clots in the legs that may travel to the lungsBreathing problemsBleeding inside your bellyHeart attack or strokeInfection, including in the lungs, urinary tract, and bellyRisks for this surgery include:Bulging tissue through the incision, called an incisional herniaDamage to nearby organs in the bodyMany episodes of diarrheaProblems with your ileostomyScar tissue that forms in your belly and causes a blockage of your intestinesShort bowel syndrome (when a large amount of the small intestine needs to be removed), which may lead to problems absorbing important nutrients and vitaminsThe ends of your intestines that are sewn together comes apart (anastomotic leak — this may be life-threatening)Wound breaking open (dehiscence)Wound infectionsBefore the ProcedureAlways tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.Talk with your doctor or nurse about these things before you have surgery:Intimacy and sexualityPregnancySportsWorkDuring the 2 weeks before your surgery:Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.Ask your doctor which drugs you should still take on the day of your surgery.If you smoke, try to stop. Ask your doctor for help.Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.Eat high fiber foods and drink 6 to 8 glasses of water every day.The day before your surgery:You may be asked to drink only clear liquids such as broth, clear juice, and water after noon.You may be asked to go through a bowel preparation to clean your intestines of all stool. This may involve staying on a liquid diet for a few days and using laxatives.Donot drink anything after midnight, including water.Yourdoctor may even tell you not to drink anything for up to 12 hours before surgery.On the day of your surgery:advertisementTake the drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureYou will be in the hospital for 3to 7 days. You may have to stay longer if your surgery was an emergency operation.You also may need to stay longer if a large amount of your small intestine was removed, or if you develop any other problems.By the second or third day, you will most likely be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.If a large amount of your small intestine was removed, you may need to receive liquid nutrition through a vein (IV) for a period of time. First you will have a special intravenous line placed in the neck or upper chest area. This intravenous line can be used to deliver nutrition.Outlook (Prognosis)Most people who have a small bowel resection recover fully. Even with an ileostomy, most people are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.If a large part of your small intestine was removed, you may have problems with loose stools and getting enough nutrients from the food you eat.If you have a chronic condition, such as cancer, Crohn disease or ulcerative colitis, you may need ongoing medical treatment.References Fry RD, Mahmoud N, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.Review Date:1/29/2013Reviewed By:John A. Daller, MD, PhD, Department of Surgery, Crozer-Chester Medical Center, Chester, PA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.