Your small intestines are very important for maintaining good digestive 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. You may need surgery to remove a damaged section of your small intestines if you have intestinal blockages or other bowel diseases. This surgery is called a small bowel resection.
A variety of conditions can damage your small bowel. In some cases, your doctor may recommend removing part of your small bowel. In other cases, part of your small bowel may be removed to confirm or rule out a disease when a “tissue diagnosis” is required. Conditions that might require surgery include:
- bleeding, infection, or severe 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:
Any surgery has potential risks, including:
- blood clots in the legs
- difficulty breathing
- reactions to anesthesia
- heart attack
- damage to surrounding structures
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, also known as an intra-abdominal abscess (which 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 area where the small intestine is reconnected (anastomosis)
- problems with stoma
- incision breaking open (dehiscence)
- infection of the incision
Before the procedure, you’ll have a complete physical exam. Your doctor will ensure that you’re receiving effective treatment for any other medical conditions, such as high blood pressure and diabetes. If you smoke, you should try to stop several weeks before surgery.
Tell your doctor if you’re taking any drugs and vitamins. Be sure to mention any medicines that thin your blood. These can cause complications and excessive bleeding during surgery. Examples of blood-thinning medications include:
- warfarin (Coumadin)
- clopidogrel (Plavix)
- aspirin (Bufferin)
- ibuprofen (Motrin IB, Advil)
- naproxen (Aleve)
- vitamin E
Let your doctor know if you’ve have recently hospitalized, 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.
Don’t eat or drink before the surgery (starting at midnight the night before). Food can cause complications with your anesthesia. This may lengthen your stay in the hospital.
General anesthesia is necessary for this surgery. You’ll be asleep and pain-free during the operation. Depending upon the reason for surgery, the procedure can take between one and eight hours.
There are two main types of small bowel resection: open surgery or laparoscopic surgery.
Open surgery requires a surgeon to make an incision in the abdomen. The location and length of the incision depend upon a variety of factors such as the specific location of your problem and build of your body. Your surgeon finds the affected part of your small intestine, clamps it off, and removes it.
Laparoscopic or robotic surgery uses three to five much smaller incisions. Your surgeon first pumps gas into your abdomen to inflate it. This makes it easier to see. They then use miniature lights, cameras, and small tools to find the diseased area, clamp it off, and remove it. Sometimes a robot assists in this type of surgery.
Finishing the surgery
In either type of surgery, the surgeon addresses the open ends of intestine. If there’s enough healthy small bowel left, the two cut ends may be sewn or stapled together. This is called an anastomosis. It’s the most common surgery.
Sometimes the intestine can’t be reconnected. If this is the case, your surgeon makes a special opening in your belly called a stoma. They attach the end of the intestine closest to your stomach to the wall of your belly. Your intestine will drain out through the stoma into a sealed pouch or drainage bag. This process is known as an ileostomy. It may be temporary to allow intestine further down the system to heal completely, or permanent.
You’ll 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. The catheter will drain urine into a bag. You’ll also have a nasogastric tube. This tube travels from your nose into your stomach. It can drain your stomach contents if necessary. It can also deliver food directly to your stomach.
You may be able to drink clear liquids two to seven days after the surgery.
If your surgeon removed a large amount of intestine or if this was emergency surgery, you may have to stay longer than one week in the hospital.
You will likely need to be on IV nutrition for some time if your surgeon removed a large section of small bowel.
Most people recover well from this surgery. Even if you have an ileostomy and must wear a drainage bag, you can resume most of your normal activities.
You may have diarrhea if you had a large section of bowel removed. You may also have problems absorbing enough nutrients from the food you eat.
Inflammatory diseases such as Crohn’s disease or small bowel cancer will likely require further medical treatment before this surgery.