What is Small Bowel Surgery?
A surgery which is done to remove a portion of the small intestine is called Small Bowel Surgery/ Small Bowel Resection, or an Enterectomy. It is performed when part of the small intestine is either blocked or diseased.
What Conditions Might Require Small Bowel Surgery?
- Infection or ulcers in the small intestine
- Precancerous polyps
- Noncancerous tumors
- Meckel’s diverticulum (a pouch of intestine present since birth)
- Crohn’s disease
- Regional enteritis
What Should I Expect Before a Small Bowel Surgery?
Before the surgery, you will need a consultation with a surgeon who will perform a physical exam and review the workup completed so far. The surgeon may need further imaging or workup. Your doctor will make sure that you are receiving treatment for other medical conditions like diabetes or high blood pressure. You should always inform your doctor about all the medications, supplements, or vitamins you are taking. Also, let your doctor know if you recently felt sick or had a fever. Just before the surgery, you may be asked to stick to a liquid diet and possibly take a laxative to clear the bowels.
How is Small Bowel Surgery Performed?
The patient is given general anesthesia for this surgery so that the procedure itself is completely pain-free and the abdominal wall is relaxed so that the surgeon can access the small bowel within the peritoneal cavity. These are the two approaches to small bowel resection:
An incision is made by the surgeon into the abdomen. The length and location of the incision depend upon many factors such as the specific location of the problem, previous incisions, and build of your body. The surgeon then finds the affected part of the small intestine, clamps it and removes it.
In laparoscopic or robotic laparoscopic surgery, 3-5 smaller incisions are made in the abdomen. Then, the surgeon pumps carbon dioxide (CO2) gas into the abdomen to inflate it. This makes it easier for the surgeon to see and work. Then, medical instruments and a small camera are passed through the incisions. The surgeon finds the diseased area, clamps it and removes it.
If there is enough amount of healthy small intestine left, the surgeon sews or staples the healthy ends back together. This is done in almost all small bowel surgery patients.
However, if it is not safe to put the bowel back together, such as a downstream problem within the colon or rectum or the patient is very compromised or ill and there is concern about inadequate healing when a connection to the colon is required, the surgeon may need to divert the intestinal stream for safety. This is done by creating an opening through the skin of the abdomen called a stoma. The small intestine is joined to the outer wall and skin of the abdomen. “Succus,” the liquid in the small bowel which is not yet technically stool and consists of digested food, comes out through the stoma into a drainage bag outside the body. This is called an ileostomy.
What Should I Expect for the Recovery Process After Small Bowel Surgery?
You will be staying in the hospital usually a minimum of 3 days after the surgery and possibly longer. You may need to stay longer if the small intestine takes longer to start to function adequately (an intestinal ileus) or if you develop any other complication. During your hospital stay, you may have a catheter in your bladder which drains to a bag, but it is removed as soon as the patient is stable and able to urinate. It will help to decompress the bladder and to accurately measure the urine amount. This catheter is usually called a “Foley” catheter. You might also require a nasogastric tube which lies within the esophagus, exits the nose and drains stomach. It helps in draining the stomach which could be full of secreted acid and bile which is not being pushed downstream into the intestine as normal. Nasogastric tubes can also be used to supply tube feeds, or liquid food, directly into the stomach. Sometimes on the evening of surgery, or ideally by at least the second or third postop day, the patient will be able to drink clear fluids. The team will slowly introduce thicker fluids and soft foods as your bowel begins to work again.