Small Bowel Resection

(Small Intestine Surgery; Ileum Surgery)

Definition

A small bowel resection is the removal of part of the small intestine. The small intestine includes the duodenum, jejunum, and ileum. The surgery can be done through an open incision or using smaller incisions using a laproscope.

Small Intestine

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Reasons for Procedure    TOP

This procedure may be done to treat the following conditions:

  • Intestinal blockage
  • Bleeding, infection, ulcers, or holes in the small intestines
  • Cancer
  • Precancerous polyps
  • Crohns disease
  • Injury

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Excessive bleeding
  • Infection
  • Blockage of the intestine caused by scar tissue
  • Hernia formation at the incision site
  • Leakage from joining of intestinal edges
  • Inability to get enough nutrients and vitamins if too much intestine needed to be removed

Factors that may increase the risk of complications include:

  • Smoking
  • Previous abdominal surgery
  • Malnutrition
  • Chronic illness
  • Drug use

What to Expect    TOP

Prior to Procedure

Your doctor may do the following:

Leading up to your procedure:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Your doctor may advise antibiotics.
  • Your intestines should be cleaned out for the surgery. During the week before surgery, eat high-fiber foods and drink plenty of water. This will encourage bowel movements. Other cleansing methods may also be recommended, including enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution that helps with the complete emptying of your intestines.
  • Begin fasting as directed by your doctor.

Anesthesia

General anesthesia—you will be asleep during the procedure

Description of Procedure    TOP

The procedure may be done with one of two methods:

  • Traditional open incision —An incision will be made into the abdomen in the area of the diseased intestine.
  • Laparoscopic technique —A few small incisions will be made in the abdomen. Carbon dioxide gas will be pumped into the abdomen through an incision. A laparoscope, which is a thin tube with a small camera on the end, will be inserted through the incisions. Special tools will also be inserted through these incisions. The laparoscope sends a view of the interior of the abdomen to a video monitor.

In either type of surgery, the small intestine will be clamped above and below the diseased section. This section will be cut free and removed.

If there is enough healthy intestine left, the free ends of the intestine may be joined together. Otherwise, a permanent or temporary ileostomy is created. An ileostomy is an opening called a stoma in the abdomen. The end of the small intestine closest to the stomach is attached to the opening. This allows intestinal contents to drain into a sealed pouch on the outside of the body. If a temporary ileostomy is created, another operation will be necessary several months later to reverse it.

Pouch Created During Ileostomy

Ileostomy and Jejunostomy
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The abdomen incisions will be closed with stitches.

How Long Will It Take?    TOP

About 1-4 hours

How Much Will It Hurt?    TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay    TOP

The usual length of stay is 5-7 days. Your doctor may choose to keep you longer if complications arise or if you had a large amount of intestine removed.

Post-procedure Care    TOP

At the Hospital

A catheter will be placed in your bladder before surgery. You will also have a nasogastric tube. This is a small tube that goes in through your nose and down into your stomach. The tube may be used to drain fluids from your stomach or to help deliver food to your stomach. The catheter and tube will remain until you are able to eat and go to the bathroom normally.

At Home

You will have some activity restrictions, such as avoiding heavy lifting. Moving around will help prevent blood clots and promote healing. Follow wound care instructions to avoid infection. Your healthcare team will teach you how to care for your ileostomy and provide you with resources.

Call Your Doctor    TOP

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Any redness, swelling, bleeding, or drainage from the incision site
  • Your bandage becomes soaked with blood
  • Stitches or staples come apart
  • Persistent nausea and/or vomiting
  • Persistent abdominal pain or bloating
  • Constipation or diarrhea
  • Rectal bleeding or tarry-colored stools
  • Pain that you cannot control with the medications you've been given
  • Cough, shortness of breath, or chest pain
  • Pain, burning, urgency, frequency of urination, or persistent blood in the urine
  • New symptoms

If you think you have an emergency, call for medical help right away.

RESOURCES:

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org
Canadian Cancer Society
http://www.cancer.ca

References:

Laparoscopic small bowel resection. Upstate University Hospital website. Available at:
...(Click grey area to select URL)
Accessed May 23, 2013.
What is a small bowel resection? Greenwich Hospital website. Available at:
...(Click grey area to select URL)
Updated May 2006. Accessed May 23, 2013.
6/3/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last reviewed January 2015 by Daus Mahnke, MD
Last Updated: 5/7/2014

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