The small intestine, commonly known as small bowel, is part of the gastrointestinal tract. It is mostly responsible for food digestion and nutrient absorption. It is about six meters long and is divided into three portions. The first and shortest part is the duodenum, followed by the jejunum, and the longest part is the ileum. The duodenum is connected to the stomach, while the ileum is connected to the large intestines.
Conditions like Crohn’s disease, ulcers, polyps, trauma, obstruction or blockage, cancer and infections, may lead surgeons to perform small bowel surgery to remove the diseased sections of the small intestine.
Small Bowel Resection Surgery
This procedure can be done through open surgery or through the laparoscopic method. Before the procedure, the patient is given specific instructions to prepare them for surgery. These include several diagnostic tests like blood tests, EKG and urinalysis to evaluate overall health of the patient. The patient is also advised to eat low residue foods for several days, and then shifting to liquid diet one day before the procedure, and nothing taken orally starting midnight. Patients are also given medications to lessen intestinal bacteria and prevent infection after the operation. Placement of an intravenous catheter, nasogastric tube and urinary catheter may also be done as part of the procedure.
At the start of the surgery, the patient is administered with general anesthesia. The abdomen is then made sterile with antiseptics, after which the surgeon makes a long incision in the middle of the abdomen to gain access inside and locate the diseased section of the small intestine to be removed. After removal of the small intestine, the two ends are then sewn or stapled together, and the incision in the abdomen is closed. In some cases, an ileostomy may be done.
In laparoscopic bowel resection surgery, instead of making a long incision in the abdomen, three to five small incisions are usually made. A laparoscope which is a long and thin tube with a camera attached at the end, and other instruments, are inserted through these incision. The laparoscope is attached to a monitor where the surgeon can visualize the inside of the abdomen. Carbon dioxide is used to inflate the stomach to allow a better view of the intestines. Once the diseased section of the abdomen is located, the area above it and below it are clamped before cutting. The ends are then sewn or stapled, and the small incisions are sutured.
Risk and Complications
Several complications may arise from the procedure, such as infection of the incision site, damage to neighboring organs, scar tissue formation which may cause obstruction, and incisional hernia. Short bowel syndrome may also occur when very large section of the small intestine is removed.
The patient is expected to stay in the hospital between seven to ten days after an open surgery and between three to five days after a laparoscopic procedure. His diet during the first day will consist mostly of liquid, with soft foods gradually introduced as the bowel regains its normal function. Most patients who have undergone the surgery experience complete healing without serious complications, although recovery time usually varies between each patient.
MedlinePlus: Small Bowel Resection
Encyclopedia of Surgery: Small Bowel Resection