Who Needs Bowel Resection Surgery?

There are many reasons for bowel resection. It depends on your child’s underlying diagnosis. The bowel digests and absorbs nutrients from food and fluid, so it must work well for good health. Many intestinal disorders are managed with medicine and diet changes. If your child’s condition does not get better with other treatments, their doctor will consider bowel resection.

Emergency bowel resection surgery is necessary when there is a blockage or leak in the bowel. It might also be needed if your child’s doctor is worried about blood flow to the stomach. This can occur for several reasons, including a twist (volvulus) or certain types of blockages that impair circulation. These situations can be life-threatening.

What Conditions Does a Bowel Resection Treat?

Bowel resection surgery may be an option to treat many conditions. Some of the most common ones include:

• Inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis
• Congenital issues (that you are born with), such as Hirschsprung’s disease, intestinal atresia, gastroschisis and volvulus
• Diseases such as necrotizing enterocolitis
• Tumors in the intestines
• Trauma to the intestines

Types of Bowel Resection Surgery

Bowel resection surgery can be done several ways. How surgery is done depends on the location of the intestine that needs to be removed.

• Laparoscopic: This surgery requires a few small cuts on the belly. The surgeon uses a laparoscope (a thin tube attached to a tiny camera) and other tools that fit through the cuts to do the surgery. It is less invasive than open surgery. The patient usually doesn’t have as much pain after.
• Open: This surgery uses a larger cut on the belly to access the intestines.
• Robotic: Robotic surgery is less common in children. The surgeon controls a robot that holds laparoscopic-type instruments. This can be more precise for areas that are hard to reach.

These surgeries can be used for a small or large bowel resection. When possible, surgeons choose laparoscopic surgery because recovery is easier for the patient. Open surgery may be used due to trauma, the size of the patient, the amount of tissue to be removed or complications.

What Happens Before a Bowel Resection Surgery?

To prepare for a bowel resection, the surgeon explains the type of surgery and the expected recovery. They will also review any possible complications.

To prepare for surgery, other steps may include:

• Blood tests
• Imaging tests – ultrasound, MRI, contrast, CT scan
• Bowel prep - cleaning the poop out of the bowel by drinking a beverage that makes the patient poop a lot
• Following special restrictions about eating or drinking before surgery
• Potential limitations or eliminating certain medicines

What Happens During a Bowel Resection Surgery?

Your child will have anesthesia to put them to sleep. They will have a breathing tube. A nasogastric tube may be put into the stomach. This keeps the stomach empty and prevents vomiting after surgery.

Some patients get a urinary catheter tube in the bladder to collect urine (pee) during and after the surgery.

The surgeon removes the damaged or blocked part of the intestine. Then they reconnect the ends of the healthy intestine with staples or stitches. They close the incision/s (cuts) and apply a bandage.

Sometimes, the ends of the bowel cannot be reconnected during surgery if the tissue is not healthy. This may be due to the patient’s condition, such as inflammation or contamination. Because the bowel contains stool (poop), tissue can become contaminated. This can prevent healing. Reconnecting the ends of the contaminated bowel may increase the risk of a leak.

The ends of the bowel also may not be reconnected due to previous treatments, including radiation and chemotherapy.

In these cases, the surgeon will create an ostomy (small hole in the abdomen) during surgery. A bag is attached to the ostomy to collect stool (poop). With an ostomy, a patient can eat normally and expel stool into the bag.

Often the ostomy is temporary. When the bowel heals, the surgeon does another surgery to reconnect the ends and close the ostomy.

Every surgery has risks. Complications from bowel resection surgery can include:

• Infection at the incision
• Blood loss, which may require a transfusion (the patient gets donated blood through a tube in a vein in their arm)
• Leakage if the resection doesn’t heal properly
• Stricture, which is when the walls of the intestine narrow and get blocked
• Adhesions, or scar tissue in the abdomen due to previous surgery
• Injury to the abdominal area

The surgeon and medical team will deal with complications immediately.

Recovery After Bowel Resection Surgery

Most children stay in the hospital for five to seven days after an uncomplicated bowel resection. They may have a longer stay depending on the procedure.

Your child will get medicine for pain and will restart eating as their bowel function returns. Usually, a patient will start with liquids, then slowly start to eat solid foods.

Your child’s medical team will evaluate how your child is doing and consider several areas for discharge. These include:

• Eating and digesting food
• Having little or controlled pain
• Having manageable bowel function
• Showing no signs of infection
• Showing healing of the incision

The medical team will give you instructions for home care, including:

• Limits on physical activity
• Diet guidance
• Medicines
• Caring for the incision

Full recovery may take a few weeks to a few months. This depends on the type of surgery and other medical conditions or potential complications.

Long-term Outlook After Bowel Resection Surgery

The goal of bowel resection surgery is to resolve or improve symptoms and help the intestines function the best they can. It is an effective treatment for many conditions.

Patients are often able to reduce or modify their medicines after surgery. The improved bowel function often results in:

• Better tolerance of food
• Increased growth
• Less pain and bloating
• Improved production of poop

Most children who have bowel resection surgery recover well. This depends on how much bowel was removed, your child’s overall health and conditions they have. With some diseases, such as Crohn’s disease, IBD and short bowel syndrome, your child may need to have additional surgeries. This is due to blockages and other issues that emerge.