Your small intestines are very important for maintaining good health. Also called the small bowel, they absorb nutrients and fluid that you eat or drink. They also deliver waste products to the large intestine. Problems with function can put your health at risk.
If you have intestinal blockages or other bowel diseases, you may need surgery to remove a damaged section of your small intestines. This is called small bowel resection.
A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend having part of your small bowel removed. Conditions that might require surgery include:
- bleeding, infection, or serious ulcers in the small intestine
- blockage in the intestines, either congenital (present at birth) or from scar tissue
- noncancerous tumors
- precancerous polyps
- injuries to the small intestine
- Meckel’s diverticulum (a pouch of intestine present at birth)
Diseases that cause inflammation in the intestines may also require surgery. Such conditions include:
- Crohn’s disease
- regional ileitis
- regional enteritis
General anesthesia is required for this surgery. You will be asleep and pain-free during the operation. The surgery can take from one to four hours.
There are two main types of small bowel resection:
- “Open” surgery requires a large (six-inch) incision (cut) in the abdomen. The surgeon finds the affected part of your small intestine, clamps it off, and removes it.
- “Laparoscopic” surgery is done through three to five much smaller holes. Gas is pumped into your abdomen to inflate it. This makes it easier to see. Miniaturized lights, cameras, and small tools are inserted into your abdomen. They are used to find the diseased area, clamp it off, and remove it. Sometimes a robot assists in this type of surgery.
In either type of surgery, the open ends of intestine must be addressed. If there is enough healthy small bowel left, the two cut ends may be sewn or stapled together. This is called anastomosis. It is the most common surgery.
Some patients cannot have the intestine reconnected. In this case, your surgeons will make a special opening in your belly called a stoma. The end of the intestine closest to your stomach will then be attached to the wall of your belly. It will drain out through the stoma into a sealed pouch or drainage bag. This process is called ileostomy. It can be temporary to allow intestine further down the system to heal completely. It can also be permanent.
You will need to stay in the hospital for five to seven days after the surgery. During your stay, you will have a catheter in your bladder. This will drain urine into a bag. You will also have a nasogastric tube. This tube travels from your nose into your stomach. It allows your stomach contents to be drained if necessary. It also allows food to be delivered directly to your stomach.
By two to three days after the surgery, you may be able to drink clear liquids.
If you had a large amount of intestine removed, or if this was emergency surgery, you may have to stay longer than one week in the hospital.
If a large section of small bowel was removed, you may need to be on IV nutrition for some time.
Before the procedure, you will have a complete physical exam. It will check that any other medical conditions, such as high blood pressure and diabetes, are being treated effectively. If you smoke, you should try to stop several weeks before surgery.
Make sure that you tell all of your doctors what drugs and vitamins you take. Be sure to mention any medicines that might thin your blood. These might cause complications and excessive bleeding during surgery. Examples of blood-thinning medications include:
- warfarin (Coumadin)
- clopidogrel (Plavix)
- ibuprofen (Motrin, Advil)
- naproxen (Aleve)
- vitamin E
Let your doctor know if you feel sick or have a fever just before surgery. You may need to delay the procedure to protect your health.
Eat a good diet of high-fiber foods and drink plenty of water in the weeks before surgery. Just before surgery, you may need to stick to a liquid diet of clear fluids (broth, clear juice, water). You also may need to take a laxative to clear your bowels.
Make sure that you do not eat or drink in the hours before the surgery (after midnight). Food can cause complications with your anesthesia. This may lengthen your stay in the hospital.
Any surgery has potential risks, including:
- blood clots in the legs
- breathing problems
- reactions to anesthesia
- heart attack
Your doctor and care team will work hard to prevent these problems.
Risks specific to small bowel surgery include:
- frequent diarrhea
- bleeding in the belly
- pus collecting in the abdomen (this may require drainage)
- intestine pushing through the incision into your belly (incisional hernia)
- scar tissue that forms an intestinal blockage requiring more surgery
- short bowel syndrome (problems absorbing vitamins and nutrients)
- leaking at the anastomosis
- problems with stoma
- incision breaking open (dehiscence)
- infection of the incision
Most people recover well from this surgery. Even if you have an ileostomy and must wear a drainage bag, you can go back to doing most of your normal activities.
If you have a large section of bowel removed, you may have problems with diarrhea. You may also have problems absorbing enough nutrients from the food you eat.
Inflammatory diseases, like Crohn’s disease or small bowel cancers, will likely require further medical treatment before this surgery.