Small bowel resection

Answer 1

Definition

Small 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 Names

Small intestine surgery; Bowel resection - small intestine; Resection of part of the small intestine; Enterectomy

Description

You will receive general anesthesia right before your surgery. This will make you unconscious and unable to feel pain.

If you have laparoscopic surgery:

• You will have 3 to 5 small incisions (cuts) in your lower belly. The surgeon passes 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.
• Your belly will be filled with gas to expand it. This makes the area easier to see and work in.

If you have open surgery, you will probably have an incision about6 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.
• Then 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 iIeostomy.

Your surgeon may also look at lymph nodes and other organs in your belly area and may remove some of them.

This surgery usually takes 1 to 4 hours.

Why the Procedure Is Performed

Small bowel resection may be recommended for:

• A blockage in the intestine caused by scar tissue or deformities
• Bleeding, infection, or ulcers caused by inflammation of the small intestine. Three conditions that may cause inflammation are regional ileitis, regional enteritis, and Crohn's disease.
• Injuries to the small intestine
• Cancer
• Precancerous polyps (nodes)
• Benign tumors

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding inside your belly
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery include:

• Damage to nearby organs in the body
• Wound infections
• Wound breaking open
• Bulging tissue through the incision, called an incisional hernia
• Short bowel syndrome (when a large amount of the small intestine needs to be removed)
• The ends of your intestines that are sewn together may come open. This is called anastomosis. This may be life threatening.
• Scar tissue may form in your belly and cause blockage of your intestines.
• Problems with your ileostomy

Before the Procedure

Always 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 sexuality
• Sports
• Work
• Pregnancy

During 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:

• Eat a light breakfast and lunch.
• You may be asked to drink only clear liquids such as broth, clear juice, and water after noontime.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
• Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions for this.

On the day of your surgery:

• Take your 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 Procedure

You will be in the hospital for 3 to 7 days. You may have to stay longer if your surgery was an emergency operation.

You also may need to stay in longer if a large amount of your small intestine was removed, or if you develop any other problems.

By the second 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 tube for a period of time. First you will have a tube that delivers nutrition into your veins, and then you will have a feeding tube that goes into your stomach.

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's disease or ulcerative colitis, you may need ongoing medical treatment.

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Coln and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Answer 2

Definition

Small 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 Names

Small intestine surgery; Bowel resection - small intestine; Resection of part of the small intestine; Enterectomy

Description

You 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 either be 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.

This surgery usually takes 1 to 4 hours.

Why the Procedure Is Performed

Small bowel resection may be recommended for:

• A blockage in the intestine caused by scar tissue or congenital (from birth) deformities
• Bleeding, infection, or ulcers caused by inflammation of the small intestine. Three conditions that may cause inflammation are regional ileitis, regional enteritis, and Crohn's disease.
• Cancer
• Carcinoid tumor
• Injuries to the small intestine
• Meckel's diverticulum
• Noncancerous (benign) tumors
• Precancerous polyps (nodes)

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding inside your belly
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery include:

• Bulging tissue through the incision, called an incisional hernia
• Damage to nearby organs in the body
• Many episodes of diarrhea
• Problems with your ileostomy
• Scar tissue that forms in your belly and causes a blockage of your intestines
• Short bowel syndrome (when a large amount of the small intestine needs to be removed), which may lead to problems absorbing important nutrients and vitamins
• The ends of your intestines that are sewn together comes apart (anastomotic leak -- this may be life-threatening)
• Wound breaking open (dehiscence)
• Wound infections

Before the Procedure

Always 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 sexuality
• Pregnancy
• Sports
• Work

During 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.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.

On the day of your surgery:

• Take 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 Procedure

You will be in the hospital for 3 to 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's disease or ulcerative colitis, you may need ongoing medical treatment.

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Coln and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Reviewed By

Review Date: 01/24/2011

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.