Small intestine resection surgery for Crohn's disease

Small intestine resection surgery permanently removes sections of the small bowel which have been damaged by Crohn’s disease, a form of inflammatory bowel disease (IBD).

What forms of Crohn's disease is small intestine resection surgery used to treat?

Crohn’s disease affecting the small intestine - ileocolitis, ileitis, jejunoileitis, and gastroduodenal Crohn's disease.

Why is small intestine resection surgery needed for Crohn's disease?

When scar tissue, caused by damage from active Crohn’s disease and healing, builds in the small intestine wall it can cause strictures (a narrowing) of the bowel or blockages. Resection surgery is used if the strictures are long, or there are several close together, as strictureplasty surgery is not possible in these situations. Resection surgery permanently removes the damaged section.

Resection can also be used to treat a hole in the wall of the small intestine or removed very diseased sections.

How is small intestine resection surgery done?

Generally resection surgery is carried out by a colorectal surgeon who is specially trained to carry out surgery on the lower digestive tract, such as the small intestines. You will likely be given a general anaesthetic for the procedure.

The surgeon identifies where the damaged section/s of the small intestine are and then removes them. The two healthy ends of the intestines are then sewed (or stapled) back together. This reattachment join is called an anastomosis.

Most people are able to have this procedure carried out through minimally invasive surgery called laparoscopic surgery (also known as key hole surgery). By doing this they can access the parts of the small intestine they need to making only small incision cuts, rather than needing to make large incisions in the abdomen.

In some cases the surgery is done in two parts, which may be several months apart. The first surgery involves removing the damaged section of the bowel and the second surgery involves attaching the two parts of the bowel together. In between the two surgeries you will be given a temporary stoma in which the two disconnected ends of the bowel are brought to the surface of your abdomen and a bag is placed over them to catch faeces (poo).

Recovering from small intestine resection surgery

On average people spend around six days in hospital, but a full recovery from resection surgery takes around four to six weeks. The time it takes can vary on your pre and post-surgery health. You may be given some specific guidelines to follow after your surgery to help aid recovery - such as a special diet, avoiding heavy lifting and not driving.

You may find that after your surgery your bowels work differently while they adapt.

Possible complications of small intestine resection surgery

• There are risks associated with any abdominal operation and you should discuss the risks specific to you with your surgeon before the operation
• Wound infections can occur at the incision sites - in both open and laparoscopic surgery. These may require antibiotics to be treated
• Resection surgery can make you vulnerable to short bowel syndrome. Your small intestine is important in absorbing nutrients from food. If too much of your small intestine is removed you can become prone to nutritional deficiencies.
• You may be prone to diarrhoea, cramping and abdominal pain for six to 12 months after surgery as your bowel adjusts to its new size
• Occasionally the join (anastomosis) between the two healthy sections of the bowel cab leak. This is known as an anastomotic leak. In some cases further surgery is required to fix the leak while in others draining of the fluid from the leak can allow the anastomosis an opportunity to heal properly

Things to know about small intestine resection surgery

• This is a common type of surgery used to treat strictures/blockages or damaged areas of small intestine
• Many people with Crohn's who have successful resection surgery do have an improved quality of life
• Many patients who undergo bowel resection will have a recurrence of the Crohn’s disease at the anastomosis (where the healthy ends of the bowel are rejoined)
• You may have a temporary stoma if the surgery is done in two parts
• The most common area to be treated using resection surgery is the last part of the small intestine called the terminal ileum
• You can also be at risk of a vitamin B12 deficiency if you have had some of the ileum removed as it is responsible for absorbing B12 from the food you eat