A bowel resection is a surgical procedure involving the removal of a diseased or damaged section of the small or large intestine. After the unhealthy portion is removed, the two remaining healthy ends are typically reconnected to restore the continuity of the digestive tract. The goal is to eliminate the source of the problem while preserving healthy bowel for normal digestion and absorption.
Conditions That Require Bowel Resection
Bowel resection is often necessary when conditions cause irreversible damage, severe blockage, or a significant risk of spreading disease within the intestines. Colorectal cancer is one of the most frequent reasons for this surgery, where the procedure aims to remove the tumor along with a margin of healthy tissue and nearby lymph nodes to prevent cancer recurrence. Resection is a primary treatment that can significantly improve survival rates.
Inflammatory Bowel Diseases (IBD), such as severe Crohn’s disease or ulcerative colitis, may also necessitate surgical intervention when medical therapies fail to control inflammation and symptoms. These conditions can cause chronic ulceration, inflammation, and scarring, leading to complications like strictures or blockages that prevent the passage of food and waste. Removing the affected segment resolves the immediate complication and offers symptomatic relief.
Complicated diverticulitis, where small pouches in the colon wall become inflamed or infected, frequently requires resection. If diverticulitis leads to serious issues like an abscess, perforation, or a fistula, the damaged section must be removed to control infection and prevent peritonitis. Acute bowel obstruction is another common indication, often caused by scar tissue from prior surgeries or by tumors that block the intestinal passage. If the blood supply to the bowel is cut off due to the obstruction, the tissue can die, requiring immediate surgical removal of the necrotic section.
Surgical Techniques and Variations
The specific approach to bowel resection is determined by the location of the disease and the extent of the tissue that needs to be removed. Surgery on the small intestine is called an enterectomy, while removal of part of the large intestine is known as a colectomy. Depending on which part of the colon is removed—such as the right side, left side, or a specific segment—the procedure may be further classified as a hemicolectomy or sigmoid colectomy.
Surgeons choose between two main approaches: open surgery or a minimally invasive technique. Open resection requires a single, larger incision in the abdomen and is reserved for complex cases, emergencies, or large tumors. Minimally invasive methods, such as laparoscopic or robotic surgery, use several small incisions through which a camera and specialized instruments are inserted.
The laparoscopic approach often results in less pain, smaller scars, and a shorter hospital stay compared to the open method. The choice depends on factors like the patient’s overall health, the nature and location of the disease, and the surgeon’s expertise. Regardless of the approach, the diseased segment is removed, and the surgeon addresses the remaining healthy ends.
The final step involves reconstruction, resulting in one of two outcomes: anastomosis or ostomy. Anastomosis is the preferred method, where the surgeon connects the two healthy ends of the bowel using sutures or surgical staples to restore normal intestinal continuity. This connection allows waste to pass through the digestive tract and exit the body naturally.
If the remaining bowel ends are inflamed, infected, or under tension, the surgeon may determine that immediate reconnection is unsafe. An ostomy is created by bringing one end of the intestine through an opening (stoma) in the abdominal wall. This diverts waste into an external collection pouch, allowing the bowel to rest and heal. The ostomy may be temporary, requiring a follow-up surgery for anastomosis later, or it may be permanent if reconnection is not possible.
Navigating the Recovery Period
Recovery is highly dependent on whether an open or minimally invasive technique was used. Laparoscopic patients generally have a shorter hospital stay (three to five days), while an open procedure may require five to seven days. Early mobilization, which involves walking as soon as possible, is encouraged to help prevent complications like blood clots and pneumonia.
Pain management is a primary focus in the post-operative phase, controlled with prescribed medications to allow for movement and deep breathing. The return of normal bowel function is a key indicator of recovery, and the diet is progressed slowly to avoid straining the newly connected intestine. Patients typically start on intravenous fluids, then move to clear liquids, and advance to a soft, low-fiber diet over several days.
For the first four to six weeks, patients must avoid heavy lifting and strenuous activity to allow the abdominal incision to heal. The total time to return to normal daily activities ranges from four to six weeks for a laparoscopic resection to six to eight weeks for an open procedure. Patients are taught to watch for signs of complications, such as fever, severe abdominal pain, or persistent vomiting, which could indicate an infection or a leak at the anastomosis site.
Dietary adjustments continue to be important during recovery as the digestive system adjusts to the changes in the bowel. A temporary low-fiber diet is often recommended to reduce the work required by the intestines, and patients are encouraged to eat small, frequent meals. While full recovery can take several months, most people resume their normal lifestyle, including work, travel, and exercise, once the surgical site has healed.