The small intestine (or small bowel) is about six meters long and lies between the stomach and colon. It is coiled up in the abdomen and divided into three sections: the duodenum, the jejunum, and the ileum. The main function of the small intestine is to digest and absorb nutrients. It also delivers waste products to the large intestine. A small bowel resection is the removal of part of or all of the small intestine as treatment for certain conditions.
A small bowel resection is a major surgery. It is performed when your small intestine is obstructed or diseased.
There are many indications that calls for small bowel resection, some common ones include;
-Obstruction or blockage in the intestines, caused by scar tissue or deformities.
-Bleeding, infection, or serious ulcers caused by inflammation of the small intestines. (This includes; Crohn’s disease, regional ileitis, and regional enteritis.)
-Noncancerous (benign) tumors.
-Precancerous polyps (nodes).
-Meckel’s diverticulum (a pouch of intestine present at birth).
-Severe loss of blood flow to the intestines.
-A small bowel resection is a definitive treatment approach to diseased small intestines that are unable to be treated by conservative approaches.
-As with all surgical procedures, an operation that involves removing part of the small bowel can come with complications.
-There may be changes to bowel function post surgery which might result in a need to adjust your diet.
-Depending on the type of surgery performed, a temporary or permanent stoma might be constructed.
Small bowel resection will require you to undergo general anesthesia. There are two approaches that the surgeon may take towards removing your small bowel. This may be in the form of a laparascopic surgery [which utilizes small incisions and cameras] and open surgery.
Laparoscopic surgery procedure: -The surgeon makes 3 to 5 small incisions in your lower belly. A laparoscope is then inserted through one of the cuts to provide vision. The scope is a thin, lighted tube with a camera on the end. It lets the surgeon see inside your belly. Other medical instruments are inserted through the other ports made by the incisions. -Another cut of approximately 5 to 8 cm may also be made if your surgeon needs to put their hand inside your belly to feel the intestine or remove the diseased segment. Once the diseased part has been located and determined it will be removed.
Open surgery procedure: -The surgeon makes an 6 to 8 inch incision at your mid-belly. The diseased part of your small intestine is located and removed. During both types of surgeries, if there is enough healthy small intestine left, the ends are stitched or stapled together. However, if there is not enough healthy small intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. The small intestine is 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 doctor will discuss with you about your health history, including any past surgeries, and any allergies you may have to medication and/or chemicals. You will then be assessed for surgery by carrying out a thorough health evaluation, including blood tests, chest x-ray, and electrocardiogram (EKG). Your doctor will also discuss wit you about your current medications that you are taking, especially any blood-thinning medication, as some will need to be stopped for 7-14 days before the procedure. Finally, you will have to fast for six to eight hours before the procedure. In case of emergency surgery, it will be performed right away.
-Immediately after surgery, you will have to continue fasting and will receive intravenous fluids instead. The doctor may order a liquid diet four to five days after the procedure and then slowly adjust this, progressing to thicker liquids and then normal food. If a large portion of the small intestine was removed, this process may take even longer. Your doctor will explain the recovery process to you.
-You will be prescribed pain medication to cope with post-surgical pain caused by the incision and surgical wounds.
-After the procedure you will have a thin tube in your nose that will travel down your throat and into your stomach to drain stomach contents. Food may also be delivered to your stomach through this tube until you are ready to eat by mouth.
-You will likely stay in the hospital for approximately five to seven days after the procedure, depending on the extent of the surgery and how much of the small intestine was removed. The more that is removed, the longer the recovery period in the hospital.
-You will be able to resume normal activities slowly, over a period of weeks and months. Don’t rush to return to all daily activities, but instead gradually ease back into your normal routine. Start by sitting up, standing, walking slowly, and so on. Your doctor will explain activity restrictions to you and you can always ask your doctor and medical team any questions you have.
Potential risks and complications that may possibly occur are as follows:
-Damage to nearby organs.
-Problems with the ileostomy.
-Scar tissue [also called adhesions] that can block the intestines.
-Short bowel syndrome may occur, which may lead to problems absorbing nutrients and vitamins.
-Reaction to anesthesia.
What are the common indications for a small bowel resection?
They may be done to:
-Treat cancer in the small intestine, colon, rectum or anus
-Treat or relieve symptoms of cancer that has spread to the intestine
-Remove a blockage in the intestine (called a bowel obstruction)
-Remove as much cancer as possible (called debulking)
-Remove precancerous conditions before they become cancer (called prophylactic surgery)
-Remove parts of the colon that are damaged by an inflammatory bowel disease or diverticulitis
-Fix a tear or hole in the intestine (called a bowel perforation)