What is Laparoscopic Small Bowel Resection

Small bowel resection is surgery to remove part of the small bowel. The small bowel, also called the small intestine, is the top part of the intestines. It is part of the digestive system. A small bowel resection may be needed if the small bowel becomes blocked or harmed by disease. The laparoscopic technique is one method used for performing this surgery. This method allows the surgery to be done through smaller incisions and allows for a faster recovery than with a regular open surgery.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Damage to other structures or organs.
• Allergic reactions to medicines.
• Leakage from where the bowel is put back together (anastomosis). This can cause the contents from the intestines to leak into the abdomen. Another surgery may be required to repair the leak.
• Long delay before the return of bowel function (ileus).
• A blood clot that forms somewhere in your veins and travels to the lung (pulmonary embolism).
• A hernia. This occurs when the abdomen bulges out. It may require surgery in the future.
• Scarring where the incision is made or inside your body, around the intestines. If this occurs, surgery may be required in the future.
• Not being able to absorb enough vitamins and nutrition through the small bowel.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.
• You may need to take medicine to clean out your bowels before surgery (bowel prep).

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have testing, such as blood tests, X-rays, or other imaging scans that take pictures of the small bowel.
• Plan to have someone take you home from the hospital or clinic. Also arrange for someone to help you with activities during recovery.
• Arrange for someone to help you with your activities during your recovery.
• Stop smoking if you smoke. Stopping will help you heal better after surgery.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or both of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Small monitors will be connected to your body. They will be used to check your heart, blood pressure, and oxygen level.
• A breathing tube will be placed into your lungs during the procedure.
• A flexible tube (catheter) will be put into your bladder to drain urine.
• A tube may be put through your nose and into your stomach (nasogastric tube, or NG tube). It will be used to remove stomach fluid after surgery until the intestines start working again.
• Several small incisions will be made in your abdomen.
• Your abdomen will be filled with air-like gas so it expands. This will give the surgeon more room to operate and will make your organs easier to see.
• A thin, lighted tube with a tiny camera on the end (laparoscope) will be put through one of the small incisions. The camera on the laparoscope will send a picture to a computer screen in the operating room. This will give the surgeon a good view inside the abdomen.
• Hollow tubes will be put through the other small incisions in your abdomen. The tools needed for the procedure will be put through these tubes.
• The portion of the small bowel to be removed will be taken out through one of the incisions.
• If the diseased bowel is too large to be removed through one of the smaller incisions:
  • The incision will be enlarged to allow the surgeon to remove the bowel.
  • The bowel repair will be made outside the abdomen and then the new bowel connection will be returned to the abdomen.
• The surgeon will connect the bowel together again.
• The incisions will be closed with staples or stitches (sutures).

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Once the nasogastric tube has been removed from your nose, you will start to take liquids by mouth.
• You will slowly be advanced back to solid foods.

Laparoscopic Small Bowel Resection, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have:

• Pain in your abdomen, especially in the incision areas. You will be given pain medicines to control this.
• Tiredness. This is a normal part of the recovery process. Your energy level will return to normal over the next several weeks.
• Constipation. You may be given a stool softener to help prevent this.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.

Incision care

• Follow instructions from your health care provider about how to take care of your incision areas. Keep your incisions clean and dry. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Use showers for bathing as told by your health care provider.
• Do not take baths, swim, or use a hot tub until your health care provider approves.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 15 lb (6.8 kg) for 4 weeks or until your health care provider says it is okay.
• Do not drive until your health care provider approves.
• Take frequent rest breaks during the day as needed.
• Take short walks often. Try to go for a 10-minute walk, 2 times a day.
• Avoid activities that take a lot of effort (are strenuous), such as running or aerobics, for at least 6 weeks or until your health care provider approves.

General instructions

• You may eat what you usually do.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain in the incision areas.
• You have more fluid or blood coming from your incisions.
• Your incisions feel warm to the touch.
• You have pus or a bad smell coming from the incision areas.
• You have a fever or chills.
• Your incisions break open.
• You have bleeding from the rectum.
• You have swelling of your abdomen.
• You cannot eat or drink without vomiting.

Get help right away if:

• You develop a rash.
• You have increasing pain in your shoulders (shoulder strap area).
• You feel dizzy or you faint while standing.
• You have shortness of breath or difficulty breathing.
• You have persistent nausea or vomiting.
• You have increased abdominal pain.
• You cannot have a bowel movement or pass gas.