Bowel Surgery

Overview

The bowel is the digestive system's lowest section. The digestive system is sometimes referred to as the gut or the gastrointestinal tract (or the GI tract or GIT for short). The bowel travels from the stomach to the anus. It is a muscular tube that is hollow. It breaks down all of the food we ingest into nutrients that the body can utilize. It also eliminates any solid waste stuff from the body in the form of poo (also called feces or stools).

 

Small bowel:

The gut is split into two sections: the small bowel (also known as the small intestine) and the large bowel (colon and rectum). The small bowel is approximately 6 - 8 m length and 2cm broad. The small bowel is divided into three sections: the duodenum, the jejunum, and the ileum.

Food travels from the stomach to the duodenum, the tube that connects the stomach to the intestines. The meal then travels through the jejunum and ileum before reaching the large intestine (colon). The small bowel (small intestine) collects nutrients as well as a large portion of the fluids from diets. Food has a porridge-like consistency when it is moved from the small intestine into the big bowel (colon).

 

Large bowel:

The big bowel (also known as the colon or large intestine) begins at the end of the small bowel and extends all the way to the rectum. The colon (large bowel) is around 2m length and 6-7 cm broad.

The ascending colon, transverse colon, and descending colon form this muscular tube, which terminates at the rectum and anus. The colon's primary function is to store, process, and eliminate waste. Some nutrients and water are also absorbed by the colon. The hundreds of thousands of bacteria residing in the colon - both 'good' and 'bad' - that comprise the gut flora are critical to this process. The rectum can hold waste, although it is usually empty. The anus is where waste is discharged.

 

What is Bowel surgery?

The bowel aids in the digestion of food and liquids, the absorption of nutrients, and the beginning of the waste disposal process. Surgery can assist if a gastrointestinal issue impairs your bowel function and produces unpleasant symptoms. In certain circumstances, partial colon removal is advised to maintain healthy bowel tissue, which can enhance your capacity to use the bathroom as well as your general quality of life.

Bowel resection surgery involves the removal of a portion of the small, large, or both intestines. The colon, rectum, and anus are all parts of the large intestine. A bowel resection is also known as: depending on whatever portions of the intestine are removed,

• A small bowel resection or small intestine resection
• A large bowel resection or large intestine resection
• A colectomy

 

Who needs Bowel surgery?

Bowel disorders and ailments can endanger your life. They can also prevent the colon or rectum from operating properly. This results in symptoms such as pain and discomfort. A bowel resection may be recommended by your doctor for one of the following reasons:

• Cancer: Cancer of the small intestine, colon, rectum, or anus can be treated by bowel surgery. The quantity of bowel removed is determined on the size and location of the malignancy. The surgeon will also remove adjacent lymph nodes.
• Diverticulitis: Diverticulosis is a condition in which tiny, bulging pouches (diverticula) form in your colon. Diverticulitis occurs when one or more of these pouches becomes inflamed or infected. Complications such as serious infection or perforation may necessitate surgery.
• Blockage: Food and fluids cannot travel through your gut when it becomes clogged. This can cut off the blood flow, resulting in tissue death.
• Severe bleeding: If doctors are unable to halt a bowel hemorrhage, that piece of the intestine may need to be removed.
• Inflammatory bowel disease: Inflammatory bowel disease (IBD) refers to a group of conditions characterized by long-term (chronic) inflammation of tissues in the digestive system. It can affect either the small or large intestine and, in some cases, requires surgery.

The particular approach you undergo will be determined by the cause for your operation and the extent to which your bowel is impacted. Depending on whatever portion of the intestine is removed, the operations are called accordingly.

 

What is small bowel resection?

Your small intestines play a crucial role in digestive health. They absorb nutrients and moisture from the food and drink you consume. They also transport trash to the big intestine. Problems with function can jeopardize your health. If you have intestinal obstructions or other bowel problems, you may require surgery to remove a damaged part of your small intestine. This procedure is known as a small bowel resection.

 

Preoperative preparation:

You will be provided a thorough physical examination before to the surgery. Your doctor will ensure that any other medical concerns, such as high blood pressure and diabetes, are well treated. If you smoke, attempt to quit several weeks before surgery.

Inform your doctor if you are taking any medications or supplements. Make a note of any medications that thin your blood. During surgery, this might lead to problems including excessive bleeding. Blood-thinning drugs include the following:

• Warfarin (Coumadin)
• Clopidogrel (Plavix)
• Aspirin (Bufferin)
• Ibuprofen (Motrin IB, Advil)
• Naproxen (Aleve)
• Vitamin E

Inform your doctor if you have recently been hospitalized, are feeling ill, or have a fever immediately before surgery. To preserve your health, you may need to postpone the treatment.

In the weeks leading up to surgery, eat a high-fiber diet and drink lots of water. You may need to follow a liquid diet of clear fluids just before surgery (broth, clear juice, water). You may also need to take a laxative to help cleanse your bowels. Before the procedure, do not eat or drink anything (starting at midnight the night before). Food might create problems with your anesthetic. This may extend your hospital stay.

 

Procedure:

This operation requires general anesthesia. During the procedure, you will be sleeping and pain-free. Depending on the purpose for the operation, the process might last anywhere from one to eight hours. Small bowel resection can be performed in two ways: open surgery or laparoscopic surgery.

Open surgery

An incision in the abdomen is required for open surgery. The length and position of the incision are determined by a number of criteria, including the precise area of your ailment and the build of your body. Your surgeon locates the damaged section of your small intestine, clamps it off, and extracts it.

Laparoscopic surgery

Three to five significantly tiny incisions are used in laparoscopic or robotic surgery. Your surgeon will first inflate your abdomen with gas. This improves visibility. They next locate the abnormal region, clamp it off, and remove it using micro lights, cameras, and small instruments. A robot may be used to aid in this sort of surgery.

The surgeon treats the open ends of the intestine in either form of surgery. If enough healthy small bowel remains, the two severed ends can be stitched or stapled together. This is known as an anastomosis. It is the most frequent type of surgery. The gut can sometimes not be rejoined. If this is the case, your surgeon will create a unique opening in your stomach known as a stoma.

They connect the end of the intestine closest to your stomach to the stomach wall. Your intestine will drain into a sealed pouch or drainage bag through the stoma. This is referred to as an ileostomy. The ileostomy might be temporary, allowing the intestine farther down the system to heal entirely, or it could be permanent.

 

Postoperative care:

After the procedure, you'll need to stay in the hospital for five to seven days. You'll have a catheter in your bladder for the duration of your stay. Urine will be drained into a bag by the catheter. You will also be fitted with a nasogastric tube. This tube connects your nose to your stomach. If required, it can empty your stomach contents. Food can also be delivered directly to your stomach.

Two to seven days following surgery, you may be able to sip clear liquids. If your surgeon removed a substantial portion of your intestine or if this was an emergency operation, you may need to stay in the hospital for more than one week. If the surgeon removed a big piece of your small bowel, you will most certainly require IV nourishment for some time.

 

Possible complications:

Any surgery has potential risks, including:

• Blood clots in the legs
• Difficulty breathing
• Pneumonia
• Reactions to anesthesia
• Bleeding
• Infection
• Heart attack
• Stroke
• Damage to surrounding structures

Your doctor and care team will work hard to prevent these problems.

Risks specific to small bowel surgery include:

• Frequent diarrhea
• Bleeding in the abdomen
• Pus in the abdomen (also known as an intra-abdominal abscess) (which may require drainage)
• Intestine pushing through the incision into your belly (incisional hernia)
• Scar tissue that forms an intestinal blockage requiring more surgery
• Short bowel syndrome (problems absorbing vitamins and nutrients)
• Leaking at the area where the small intestine is reconnected (anastomosis)
• Problems with stoma
• Incision breaking open (dehiscence)
• Infection of the incision

 

What is colorectal surgery?

A colectomy is a surgical procedure that removes part or all of your colon. It is also known as colon resection surgery. A colectomy may be required if part or all of your colon has ceased working or if it has an incurable illness that puts other sections of your body at risk. Colon cancer and inflammatory bowel disease are two common causes.

 

Preoperative preparation:

Your healthcare team will assess your surgical readiness before arranging a colectomy. This may involve, in addition to a physical assessment and a health history:

• Blood tests.
• X-ray.
• Electrocardiogram (EKG) test.
• Urinalysis.
• Colonoscopy.

Before you sign your consent, your healthcare staff will want to ensure that you understand everything about the treatment. They'll advise you on surgical risks and how to live with a colostomy if you need one. And the pain management alternatives.

It is critical that your bowels be empty before undergoing surgery. You should start planning for this a few days ahead of time. Your healthcare provider may request that you:

• Consume only a clear liquid diet.
• Fast before the procedure (no food or drinks).
• Take a laxative or enema to clear out your bowels, like polyethylene glycol. These bowel preparations come with their own specific instructions.

 

Procedure:

The specifics of your colectomy surgery will be determined by the kind of procedure and the surgical approach employed. However, there will be a broad pattern to the procedure. In general, you can expect your provider to:

1. Put you to sleep with general anaesthetic.
2. Make one or more abdominal incisions (belly area).
3. Carefully separate and remove the diseased colon tissue.
4. Use staples or sutures to join the healthy bowel ends.
5. Or make a stoma and route your bowel end to it.
6. Close your abdominal incisions.

Your surgeon may conduct a typical open colectomy or a minimally invasive laparoscopic colectomy.

• Open surgery entails making a single lengthy incision through your abdomen. This procedure allows for the most convenient access to your organs and may be required if your condition is more difficult or if you are undergoing emergency surgery.
• Laparoscopic surgery is carried out through a number of small incisions with the use of a tiny video camera known as a laparoscope. If you are having a laparoscopic/robotic colectomy, the surgeon will start with a single tiny incision to insert the laparoscope. They'll inject gas through the incision to expand your abdominal cavity and project your organs onto a video screen. One or more further small incisions will allow your surgeon to reach your colon with special instruments through one or more additional minor incisions.

 

Types of surgery:

You may need all or part of your colon removed. Different operations to remove different parts of the colon have different names.

Total colectomy

A total colectomy involves the removal of your whole colon. The majority of your big intestine is located here. It starts at the end of your small intestine and terminates at the rectum, which is the tail end of your large intestine that feeds into the anal canal.

Partial/subtotal colectomy

A subtotal or partial colectomy involves the removal of a piece of your colon. Your procedure may be referred to by a more precise name that refers to the portion of your colon that is being removed. As an example:

• Sigmoid colectomy. A sigmoid colectomy, sometimes known as a sigmoidectomy, is a surgical procedure that removes the final piece of your colon, known as the sigmoid colon. This is the section that attaches to your rectum.
• Hemicolectomy. A hemicolectomy involves the removal of one side of your colon. The descending colon, which runs downhill on the left, is removed during a left-side hemicolectomy. This is located in the second portion of your colon. The ascending colon, which runs upward on the right side, is removed during a right-side hemicolectomy. This is the first half of your colon.
• Proctocolectomy. A proctocolectomy involves the removal of a portion of the colon as well as the rectum. "Procto" is Latin for "rectum." (A total proctocolectomy involves the removal of the whole colon and rectum.)

 

Finishing the procedure:

After your large bowels have been resected, your surgeon may be able to immediately reconnect the severed ends. Or they may have to wait and participate in another procedure later. Sometimes they are unable to reattach your bowels. One of these operations will follow your colectomy:

• Anastomosis. Anastomosis occurs when the two ends of your bowels are linked together, reuniting your intestines. This is how many, if not most, colectomies end.
• Colostomy / Ileostomy. If your bowels are unable to be rejoined during your colectomy, your surgeon will construct a stoma in your abdominal wall. The top section of your intestines will be sent to the stoma. If the initial section of your colon that linked to your small intestine was removed during your colectomy, the end of your small intestine will be rerouted to your stoma. This is known as an ileostomy, after the ileum, the last section of the small intestine. If the colectomy removes a segment of your colon from the middle or end, the upper portion of your colon will be rerouted to your stoma in a colostomy. These procedures might be either temporary or permanent.
• Ileal pouch. If you underwent a total proctocolectomy, which removed your whole colon and rectum, you may be a candidate for an ileo-anal anastomosis. With the insertion of an ileal pouch, your ileum can be linked directly to your anus. The pouch serves as an internal substitute for a colostomy or ileostomy bag. Your surgeon builds the pouch from the ileum to act as a reservoir for waste storage, similar to what your rectum used to do. This technique is frequently performed during follow-up procedures, but it can also be performed as part of your proctocolectomy surgery.

 

Postoperative care:

You'll be in the hospital for a few days before being released. It might take two days or up to a week, depending on the type of procedure and how well you recover. During this time, you’ll be:

• Monitored for any signs of complications from the procedure.
• Gradually weaned from your pain medication.
• Fed with a liquid diet or soft diet.
• Waiting for your bowels to begin functioning again.

You’ll also receive counseling on how to take care of yourself when you get home. This may include:

• Wound care.
• Ostomy care.
• Dietary advice.

Home recovery might take up to six weeks. Many patients resume most of their normal habits after two weeks of surgery. In the first few days after you return home, try to be especially careful with yourself. Walking about is excellent for you, but it may make you feel weak. Do not attempt to do too much too quickly.

 

Possible complications:

Complications, like with any surgery, are always possible. Colectomy complications may include:

• Bleeding.
• Infection.
• Injury to nearby organs.
• Anastomotic leak.

Call your provider anytime you have concerns, especially if you have:

• Redness, swelling or foul odor near the incision site.
• Any pain (especially around your belly) that gets worse over time.
• No bowel movements after returning home.
• Signs of infection like fever or vomiting.

 

General complications of bowel surgery

Complications are issues that might arise during or after surgery. Any procedure might have consequences such as an unanticipated response to the anesthesia or developing a chest infection afterwards. Excessive bleeding or the formation of a blood clot, commonly in a vein in your leg, are additional possible complications (deep vein thrombosis, DVT).

Specific complications of bowel surgery include the following.

• Leakage of the new bowel junction (an anastomotic leak). This might result in severe abdominal pain and a high temperature. If you have an anastomotic leak, you may need to be admitted to the hospital for additional treatment and surgery.
• A wound infection. Your wound may swell, turn red, and become painful to the touch. You can also have a fever and feel ill. If you have any of these symptoms, you should contact your local hospital.
• Bands of scar tissue (adhesions). These can occur following surgery and cause your tissues or organs to adhere together. Adhesions can cause persistent abdominal pain and clog your bowel. You might be able to have a surgery to separate them.
• Temporary paralysis of your bowel (ileus). It takes time for your bowel to resume normal function. You may feel bloated, nauseated, or have bowel movements issues. If you aren't improving after a few days, your medical staff will give you fluids to assist you recuperate.
• Nerve damage. If nerves in your pelvic region are injured during surgery, you may lose sensation. This might have an impact on your sexual life or your bladder control.

 

Conclusion

In general surgery, small bowel resection is a frequent operation. In most cases, the length of the small bowel enables for easy resection with minimal impact on gastrointestinal (GI) system function. A small bowel resection is performed for a variety of reasons. While the essential concepts of a small bowel resection are almost universal, disease may need adjustments to the surgical method.

A colectomy is a surgical procedure that removes all or part of your colon. It is also known as colon resection surgery. Because your colon is a portion of your large bowel, colectomy is a form of big bowel resection. For a variety of reasons, you may need to have part or all of your colon removed. Cancers and illnesses that cannot be treated with drugs are examples of this. Removing the damaged section allows the remainder of your gastrointestinal tract to function normally.