Definition

Small bowel resection is surgery to remove a part of your small bowel. It is done when part of your small bowel is blocked or diseased.

The small bowel is also called the small intestine. Most digestion (breaking down and absorbing nutrients) of the food you eat takes place in the small intestine.

Alternative Names

Small intestine surgery; Bowel resection - small intestine; Resection of part of the small intestine; Enterectomy

Description

You will receive general anesthesia at the time of your surgery. This will keep you asleep and pain-free.

The surgery can be performed laparoscopically, with a robot, or open surgery.

If you have laparoscopic or robotic surgery:

• Your surgeon makes 3 to 5 small cuts (incisions) in your lower belly. A medical device called a laparoscope is inserted through one of the cuts. 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 cuts.
• A cut of about 2 to 3 inches (in) or 5 to 7.6 centimeters (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.
• Your belly is filled with a harmless gas to expand it. This makes it easier for your surgeon to see and work.
• The diseased part of your small intestine is located and removed.

If you have open surgery:

• The surgeon makes a cut of 6 to 8 in (15.2 to 20.3 cm) in your mid-belly.
• The diseased part of your small intestine is located and removed.

In both kinds of surgery, the next steps are:

• If there is enough healthy small intestine left, the ends are stitched or stapled together. This is called an anastomosis. Most patients have this done.
• If there is not enough healthy small intestine to reconnect, your surgeon makes 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.

Small bowel resection usually takes 1 to 4 hours.

Why the Procedure Is Performed

Small bowel resection is used to treat:

• A blockage in the intestine caused by scar tissue or congenital (from birth) deformities
• Bleeding, infection, or ulcers caused by inflammation of the small intestine from conditions such as Crohn disease
• Cancer
• Carcinoid tumor
• Injuries to the small intestine
• Meckel diverticulum (a pouch on the wall of the lower part of the intestine that is present at birth)
• Noncancerous (benign) tumors
• Precancerous polyps
• Foreign object in the small bowel

Risks

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Blood clots, bleeding, infection
• Nausea and vomiting

Risks of having this surgery include:

• Bulging tissue through the incision, called an incisional hernia
• Damage to nearby organs in the body
• Diarrhea
• Problems with your ileostomy
• Scar tissue that forms in your belly and causes a blockage of your intestines
• Short bowel syndrome (when a large amount of the small intestine needs to be removed), which may lead to problems absorbing important nutrients and vitamins
• Chronic anemia
• The ends of your intestines that are sewn together come apart (anastomotic leak, which may be life threatening)
• Wound breaking open
• Wound infection

Before the Procedure

Talk with your surgeon or nurse about how surgery will affect:

• Intimacy and sexuality
• Pregnancy
• Sports
• Work

Tell your surgeon or nurse if:

• You are or could be pregnant.
• You are taking any medicines, including medicines, drugs, supplements, or herbs you bought without a prescription.
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day. 

Planning for your surgery:

• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the health care provider who treats you for these conditions.
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery
• During the week before your surgery:
• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners. 
• Ask your surgeon which medicines you should still take on the day of your surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.
• You may be asked to go through a bowel preparation to clean your intestines of all stool. This may involve staying on a liquid diet for a few days and using laxatives.

On the day of your surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

After the Procedure

You will be in the hospital for 3 to 7 days. You may have to stay longer if your surgery was an emergency operation.

You also may need to stay longer if a large amount of your small intestine was removed or you develop problems.

By the second or third day, you will most likely be able to drink clear liquids. Thicker fluids and then soft foods will be added as your bowel begins to work again.

If a large amount of your small intestine was removed, you may need to receive liquid nutrition through a vein (IV) for a period of time. A special IV will be placed in your neck or upper chest area to deliver nutrition.

After you go home, follow instructions on how to take care of yourself as you heal.

Outlook (Prognosis)

Most people who have a small bowel resection recover fully. Even with an ileostomy, most people are able to do the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

If a large part of your small intestine was removed, you may have problems with loose stools and getting enough nutrients from the food you eat.

If you have a long-term (chronic) condition, such as cancer, Crohn disease or ulcerative colitis, you may need ongoing medical treatment.

References

Albers BJ, Lamon DJ. Small bowel repair/resection. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 92.

Padilla PL, Khoo KH, Ho T, Cole EL, Sirvent RZ, Phillips LG. Small intestine. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 69.