What is Open 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. When food leaves the stomach, it goes into the small bowel. Most food is then absorbed into the body.

A small bowel resection may be needed if the small bowel becomes blocked or harmed by disease. One type of procedure is called an open resection. An open surgery means that the surgeon will make a long incision to open up your abdomen for the procedure.

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:

• Bleeding.
• Infection.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• A blood clot that forms somewhere in the veins and travels to the lung (pulmonary embolism).
• Leaking of intestinal fluids into the abdomen.
• 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.
• Arrange for someone to help you with your activities during recovery.

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. Medicine will flow directly into your body through the IV tube.
• 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).
• Several tubes may be put into your body.
  • A tube in your throat will help you breathe during the procedure. It may also be used to give you anesthetic gas during the procedure.
  • A nasogastric tube will go through your nose and into your stomach. Fluids from your stomach will drain through this tube during and after the procedure.
  • A thin, flexible tube (catheter) in your bladder will drain urine during and after the procedure.
• An incision will be made in the middle of your abdomen.
• The surgeon will remove the affected piece of small bowel and then join the bowel together again with staples or stitches (sutures). This will allow digested food to pass through again.
• The surgeon will close the incision with staples or sutures.

The procedure may vary among health care providers and hospitals.

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.
• You will be given medicine for pain as needed.
• You will continue to get fluids through the IV tube for a while. Also, the nasogastric tube may stay in for a few days until your bowels are working again.
• After the nasogastric tube is out, you can start eating food again. You will start with liquids and then advance to more solid foods.
• You will be asked to get up and start walking within a day. This helps to keep blood clots from forming in your legs.
• You may be told to breathe deeply and to cough now and then. This keeps your airways open.

Open 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 the procedure, it is common to have:

• Pain in your abdomen, especially along your incision. 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.

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 10 lb (4.5 kg) until your health care provider says that it is safe.
• Take frequent rest breaks during the day as needed.
• Try to take short walks every day for the amount of time that your health care provider suggests.
• Avoid activities that require a lot of effort (are strenuous) for as long as told by your health care provider.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. 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 area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.

General instructions

• Continue to practice deep breathing and coughing. If it hurts to cough, try holding a pillow against your abdomen as you cough.
• 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 as told by your health care provider. These include 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 pain that is not relieved with medicine.
• You do not feel like eating.
• You feel nauseous or you vomit.
• You have constipation that is not relieved with prescribed stool softeners.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.

Get help right away if:

• Your pain gets worse, even after you take pain medicine.
• Your legs or arms hurt or become red or swollen.
• You have chest pain.
• You have trouble breathing.