A bowel resection is a surgical procedure involving the removal of a diseased or damaged section of the intestine, which consists of the small and large bowel. The specific section removed is determined by the location of the problem. After the affected segment is taken out, the remaining healthy ends of the bowel are typically reconnected in a process known as an anastomosis. This operation removes the source of the disease and restores intestinal continuity.
Medical Conditions Leading to Resection
Colorectal cancer is a frequent indication for bowel resection. The surgeon removes the tumor along with a margin of healthy tissue and nearby lymph nodes to achieve a cure or prevent disease spread. The extent of the resection depends on the size and location of the cancerous growth.
Chronic inflammatory conditions, such as Crohn’s disease and ulcerative colitis, may require resection when medical treatments fail or complications arise. Crohn’s disease can cause strictures, fistulas, or deep ulcerations, making surgical removal of the damaged segment necessary. Ulcerative colitis may necessitate a colectomy (removal of the entire large intestine) if inflammation is widespread or if precancerous changes are detected.
Severe diverticulitis, the inflammation and infection of small pouches (diverticula) in the colon lining, can lead to complications requiring surgery. If a diverticulum ruptures, causing a perforation, or if the infection is recurrent, the affected segment must be removed to prevent peritonitis. Other acute issues also necessitate resection, including bowel ischemia (loss of blood supply), uncontrollable bleeding, or physical obstructions caused by scar tissue or twisting (volvulus).
Pre-Surgical Preparation Steps
Patients undergo pre-operative steps to prepare the body and minimize infection risk. Testing includes blood work and imaging scans, such as CT scans, to assess overall health and precisely map the diseased area. These tests ensure the patient is prepared for general anesthesia and the physical stress of surgery.
A major preparatory step involves dietary restrictions and, often, a full bowel cleansing. Patients are typically restricted to a clear liquid diet for a day or two leading up to the procedure to reduce the volume of contents in the intestine. The bowel preparation involves drinking a large volume of a special laxative solution or using enemas to completely empty the colon of stool.
Medication adjustments are required, particularly the temporary discontinuation of blood-thinning agents, such as aspirin, several days before surgery to reduce bleeding risk. Surgeons may also prescribe oral antibiotics to reduce the bacterial load within the colon, lowering the chance of post-operative infection.
Surgical Techniques and Approaches
Bowel resection procedures are divided into two categories based on the surgical approach: open surgery or minimally invasive surgery. Open surgery, or laparotomy, involves the surgeon making a single, long incision in the abdomen, which provides direct and extensive access to the abdominal cavity. This method is often reserved for complex cases, emergency situations like trauma or widespread infection, or when very large tumors are present.
Minimally invasive approaches, including laparoscopic and robot-assisted surgery, use several small incisions, typically less than an inch long. Specialized instruments and a laparoscope, a thin tube with a camera, are inserted through these small ports, allowing the surgeon to operate while viewing a magnified image on a monitor. Laparoscopic techniques lead to less post-operative pain, a shorter hospital stay, and a faster return to normal activities compared to the open method.
The operation involves identifying the diseased portion and carefully dividing the tissue and associated blood vessels (mesentery) to remove the segment. Removal of part of the large intestine is termed a colectomy, while removal of part of the small intestine is a small bowel resection. The remaining healthy ends are then reconnected using sutures or surgical staples to re-establish the continuity of the digestive tract.
In certain situations, the surgeon may determine that an immediate anastomosis is too risky, such as in cases of severe infection or when the remaining bowel is too inflamed to heal properly. In these instances, an ostomy may be created, where one end of the bowel is brought through an opening in the abdominal wall, called a stoma, to divert waste into an external collection bag. This stoma may be a temporary measure, intended for later reversal once the bowel has healed, or it may be a permanent solution depending on the extent of the resection and the patient’s underlying condition.
Immediate and Long-Term Recovery
The immediate recovery phase begins in the hospital, where the patient’s pain is managed through a multimodal approach, often involving a combination of medications. Monitoring the surgical incision for signs of infection and observing for potential complications, such as leakage at the anastomosis site, are priorities during this period. Patients are encouraged to get out of bed and walk on the first day after surgery, as early mobilization helps stimulate bowel function and reduces the risk of blood clots.
Dietary progression is gradual, starting with clear liquids and advancing to a low-fiber diet as the digestive system restarts, a process that can take several days. The length of the hospital stay varies significantly, typically ranging from three to five days for minimally invasive procedures and five to seven days for open surgeries. A key milestone for discharge is the return of normal bowel function, which signals that the anastomosis is likely intact and the digestive tract is working again.
Long-term recovery involves a slow return to full activity, with most patients avoiding heavy lifting or strenuous exercise for four to six weeks to allow the abdominal wall incisions to heal completely. Patients who underwent a laparoscopic procedure typically achieve full recovery faster, often within four to six weeks, while open surgery recovery may take six to eight weeks. Many patients experience changes in bowel habits, such as increased frequency or looser stools, but these often improve as the body adapts.
If a temporary ostomy was created, a second, less extensive surgery is planned, usually several months later, to reverse the procedure and reconnect the bowel ends internally. Patients may need to make ongoing dietary adjustments, focusing on hydration and a balanced diet, to manage their new digestive system.