What does a bowel resection involve?
Resection of the small or large bowel may be required as an elective or emergency procedure. It usually involves removing part of the bowel and re-joining the bowel forming an anastomosis (or a “join”). Sometimes, joining the bowel back together is not possible and a temporary or permanent stoma (bag) is formed.
Surgery may be laparoscopic (key-hole) or open. If done laparoscopically, one of the incisions is enlarged to allow the bowel to be removed and the anastomosis to be fashioned.
The resected bowel is sent to the pathology laboratory to be analysed and looked at under the microscope. The results are usually available within a week and are discussed at the follow up appointment.
What are the risks of surgery?
Surgical procedural risks can be divided into anaesthetic and surgical risks.
Anaesthetic risks are usually discussed with the patient by the anaesthetic team.
Surgical risks specific to bowel resection relate to:
- The wound – infection, bleeding, hernia
- The anastomosis – if the join leaks, it can result in a collection of pus in the abdomen which may be localized around the anastomosis or cause a generalized leak inside the whole abdomen. The risk of a leak depends on the type and site of the anastomosis and is highest in the first 5 days after surgery. It may require radiological drainage or return to the operating theatre for more surgery.
Other risks of major surgery include:
- Deep venous thrombosis or DVT: formation of blood clots in the legs. This risk is reduced by wearing compression stockings (called TEDS), injection of blood thinning medications (Clexane) and mechanical calf-compression.
- Chest infection: This is prevented by adequate pain-relief, deep breathing, early mobilization and chest physiotherapy.
- In hospital:
Pain usually depends on the size of incision and degree of dissection.
You will be prescribed regular pain-killers during your hospital stay.
You are also likely to have a PCA (patient-controlled anaelgesia). This is a button you can press which delivers strong pain-killers directly into your blood stream.
- Upon discharge:
Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation which results in more straining.
Bowel function takes a few days to return to normal following a bowel resection and post-surgical diet depends on the speed at which normal bowel function returns. It usually starts as clear fluids and is built up to a normal diet prior to discharge from hospital.
You may have a urinary catheter put in at the time of surgery to monitor your urinary output and prevent retention which may be caused by pain or immobility.
This will be removed as early as possible depending on whether or not monitoring of urinary output is required and how mobile you are.
Early mobilization is vital in preventing complications such as chest infection and DVT. You will be encouraged to sit out of bed and go for a walk (under supervision at least initially). Physiotherapists play an essential role in this part of your recovery.
The skin may be closed with dissolving sutures, non-dissolving sutures or staples.
If staples on non-dissolving sutures are used, these are usually removed after 11-12 days.
A waterproof dressing is used which stays on for 7 days.
If the dressing is wet, it is important to report this to your nurse or doctor as it needs to be changed. If this happens after you leave hospital, you need to see your local doctor or contact us.
After 7 days, when this dressing is removed, it is okay for the sutures or staples to be exposed to air and to have a shower without covering the wound.
You cannot go for a swim or soak the wound in a bathtub for at least 2 weeks or until after your follow up wound review.
Dressings are usually in two layers – Steristrips with a padded-Opsite on top.
These are waterproof so you can shower but cannot swim or have a bath for 2 weeks or until after your follow up wound review.
The top dressing stays on for 5-7 days.
Once the top dressing comes off, leave the Steristrips on for a few more days until they start to peel off by themselves.
You should avoid any heavy lifting or straining for 6 weeks after surgery to avoid an incisional hernia.
Patients will typically spend 3-5 days in hospital following a bowel resection. However, duration of stay as well as speed of recovery depends on the specific type of bowel resection, whether it was done as an emergency and other patient factors.
A wound review by your surgeon or local doctor is advisable 1-2 weeks after surgery. This is when staples or sutures will be removed if required and pathology of the resected bowel will be discussed.
The appointment is usually made for you by the ward clerk before leaving the hospital.