Bowel resection is a surgical procedure that involves removing a section of the intestines. It becomes necessary when a portion of the bowel is diseased or damaged.
Defining Bowel Resection
Bowel resection is a surgical operation that removes a part of either the small or large intestine. When the small intestine is involved, it is called a small bowel resection. For the large intestine, which includes the colon and rectum, the procedure is often called a large bowel resection or colectomy. Surgeons remove the affected section along with some surrounding healthy tissue. The remaining healthy ends are typically reconnected, a process known as anastomosis, to maintain the continuity of the digestive tract. This procedure aims to eliminate diseased tissue, alleviate symptoms, and restore bowel function.
Reasons for the Procedure
Several medical conditions can necessitate a bowel resection. Inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis, which cause chronic inflammation, are common reasons for this surgery. In Crohn’s disease, surgery might be needed to remove damaged portions or repair strictures and fistulas.
Diverticulitis, an inflammation or infection of small pouches in the digestive tract, can also lead to resection, especially in cases of severe infection or recurring episodes. Bowel obstruction, where a blockage prevents the passage of food and liquid, often requires surgical intervention to remove the cause, such as scar tissue or tumors. Intestinal cancers frequently necessitate resection to remove cancerous tissue and nearby lymph nodes. Severe gastrointestinal bleeding, injuries to the intestines, or precancerous polyps may also indicate the need for a bowel resection.
Surgical Approaches
Bowel resections can be performed using different methods, primarily open surgery or minimally invasive techniques like laparoscopic surgery.
Open surgery, also known as laparotomy, involves a single, larger incision, typically 6 to 8 inches long, made in the abdomen. Through this incision, the surgeon directly accesses and removes the diseased part of the bowel. This traditional approach allows for a wide view of the surgical area.
Laparoscopic surgery, a minimally invasive option, involves several smaller incisions, usually three to five, in the abdomen. A thin tube with a camera, called a laparoscope, is inserted through one incision, projecting images onto a monitor, allowing the surgeon to view the internal organs. Specialized surgical instruments are then passed through the other small incisions to perform the resection. This method generally results in less pain, smaller scars, and a potentially faster recovery compared to open surgery.
The specific type of resection performed depends on the location and extent of the diseased bowel. For the large intestine, procedures include:
Partial colectomy, which removes a segment.
Hemicolectomy, which removes one side of the colon (right hemicolectomy removes the ascending colon and part of the transverse colon; left hemicolectomy removes parts of the transverse, descending, and sigmoid colon).
Sigmoid colectomy, which removes the sigmoid colon.
Total colectomy, which involves removing the entire colon.
Proctocolectomy, if the rectum is also removed.
Post-Operative Expectations
Following a bowel resection, patients typically remain in the hospital for a few days, often between 3 to 7 days, depending on the type of surgery and individual recovery. Pain management is a priority, and medication is provided to alleviate discomfort. Shortly after surgery, patients are encouraged to begin gentle activities, such as walking, which helps promote healing and can aid in the return of bowel function.
Dietary progression usually starts with clear liquids, gradually advancing to soft, low-fiber foods as the bowel begins to recover. Full recovery and a return to a regular diet can take several weeks, often between 4 to 8 weeks. Patients are advised to avoid heavy lifting for about 6 to 8 weeks to prevent complications like hernias. Monitoring for signs of complications is important, and patients receive instructions on wound care and what symptoms to report to their healthcare team.