Small bowel resection

Your small intestine — made up of three sections called the duodenum, jejunum, and ileum — is the long tube that absorbs most of the nutrients from the food you eat. When part of it becomes diseased or blocked, surgery may be needed to remove that section and join the healthy ends back together. How much is removed depends on how far the disease has spread; sometimes it's just a few centimetres, other times a longer stretch.

One part worth knowing about is the terminal ileum — the very last section of your small bowel. It's responsible for absorbing vitamin B12 and bile salts (which help you digest fat). If that section needs to come out, we'll monitor your nutrition carefully and arrange supplements so you don't miss out.

This surgery is performed using keyhole (laparoscopic or robotic) techniques in most planned cases. Published studies show smaller cuts are associated with less post-operative pain and a quicker return home compared with traditional open surgery.

If your operation is being done for a small bowel cancer or tumour, see also the Bowel Cancer Surgery hub for the broader picture. If you are having this for an obstruction caused by adhesions, see the Adhesiolysis & Surgery for SBO page and the Adhesions & Recurrent SBO condition page for more context. For Crohn's-driven surgery, see the IBD condition page.

• Crohn's disease — the most common reason for this surgery. When medication is no longer controlling the inflammation, or when the bowel has narrowed (a stricture), developed a fistula (an abnormal tunnel to another organ), or formed an abscess, surgery may be the best option.
• Small bowel tumours — including adenocarcinoma (a type of cancer), gastrointestinal stromal tumours (GIST), carcinoid or neuroendocrine tumours, and lymphoma.
• Small bowel obstruction — when the bowel is completely blocked, often by adhesions (internal scar tissue from a previous operation) or a hernia, and a section of bowel has been damaged or lost its blood supply.
• Strictures — narrowings caused by inflammation, previous surgery, or radiation that keep blocking your bowel and can't be stretched open with an endoscopic procedure.
• Mesenteric ischaemia — when the blood supply to part of the bowel is cut off, causing that section to die. This is an emergency situation.
• Radiation enteritis — damage caused by radiotherapy to the pelvis or abdomen, leading to narrowing, fistulas, or bleeding in the small bowel.
• Meckel's diverticulum — a small pouch that some people are born with on their small bowel, which can cause bleeding, blockage, or infection.
• Trauma — bowel injury from an accident that requires a section to be removed.

You'll be completely asleep under general anaesthesia for the whole operation. The approach used — keyhole or open — depends on how urgent things are, how much of the bowel is affected, and whether you've had previous abdominal surgery.

Keyhole (laparoscopic) approach

For planned surgery, the operation is performed through 3–4 small cuts, each about 1 cm. A camera and fine instruments are passed through these openings. The diseased section of bowel is carefully separated from its blood supply, then brought out through a small, protected incision (usually 3–5 cm) to be removed. The two healthy ends of bowel are then joined back together — either with surgical staples or with stitches, depending on what's safest for you.

Open approach

Sometimes — especially in an emergency, or when the bowel is perforated or heavily scarred from previous surgery — a longer incision is needed. The steps are the same, just through a bigger opening. This approach is chosen when it's the safest option, not because it's better or worse.

Will I need a stoma (bag)?

In most planned operations, the bowel ends are joined directly and you won't need a bag. Occasionally, if your bowel is very inflamed, you've lost a lot of weight, or it isn't safe to make the join right away, a temporary ileostomy (a bag on the abdomen that collects waste while the join heals) may be needed. If that happens, closing it is planned for a few months down the track once you've recovered well.

Full bowel preparation is not routinely needed for small bowel resection — if a prep is required for your particular operation, you will be given specific instructions when you book. If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure.

• Imaging to plan the operation — usually a CT scan, and sometimes an MRI or a capsule endoscopy (a tiny swallowable camera) depending on your situation
• Blood tests to check your general health, kidney and liver function, and nutritional levels including albumin, B12, folate, and iron
• A review with the anaesthetist before the day of surgery
• Bowel preparation (a laxative drink to clear the bowel) is not routinely needed — you will be told if your particular operation requires it
• If you're on immunosuppressant or biologic therapy for Crohn's disease, some medications may need to be paused beforehand — you'll receive personalised guidance on this
• If you've lost a lot of weight or your nutrition is poor, building your nutrition up before surgery may be recommended — this improves how well you heal

• You'll arrive at Warringal Private Hospital or Epworth Eastern on the morning of your surgery and be admitted to the ward
• The anaesthetist will send you off to sleep; a urinary catheter (a small tube to drain your bladder) may be placed while you're under, depending on the procedure
• The diseased section of bowel is removed and the healthy ends are joined back together
• The operation usually takes between 1.5 and 3 hours, depending on how complex things are
• You'll wake up in the recovery area, then be moved to the surgical ward — the team will encourage you to sip fluids and get up for a short walk that first day, which really does help you recover faster

• In hospital (3–5 days): You'll start with clear fluids and progress to a normal diet over 2–3 days as your bowel wakes up. Pain is managed with paracetamol and anti-inflammatories; stronger pain relief is available if you need it. Getting up and walking — even a lap of the ward — speeds your recovery.
• Weeks 1–2: Rest at home and take it easy, but gentle short walks every day are encouraged. A nurse or the practice team will check your wounds as needed.
• Weeks 2–4: You can gradually do more around the house. Your bowel habits may feel different for a while — looser, more frequent — and this is completely normal as your gut adapts to its new configuration. If your terminal ileum was removed, B12 supplementation will be arranged.
• Weeks 4–6: You should be able to return to desk work and driving once you're comfortable and no longer taking strong pain relief. Avoid heavy lifting for 6 weeks to let everything heal properly inside.
• A post-operative review is arranged 2–6 weeks after your surgery, depending on the operation — this appointment is provided at no charge.

Common

• Altered bowel habit — loose stools or needing to go more often, especially if the terminal ileum was removed. This usually settles over weeks to months as your gut adapts.
• Wound infection or bruising (haematoma) — the wound may become red or sore. This is manageable and usually responds well to antibiotics or a simple dressing change.
• Post-operative ileus — your bowel can go quiet for a few days after surgery (this is normal — it's been handled). You'll be on fluids until it wakes up, which usually happens within 2–3 days.
• Fatigue — you'll likely feel tired for 2–4 weeks. This is your body healing. It does pass.

Less common

• Anastomotic leak — occasionally the bowel join doesn't heal as it should. This happens in around 2–5% of cases and may require further treatment or a temporary stoma. The team monitors for this closely in the first few days after surgery.
• Nutritional deficiencies — if a significant length of terminal ileum is removed, your body may struggle to absorb vitamin B12, fat-soluble vitamins, or bile salts. Blood tests and supplements are arranged to stay on top of this.
• Adhesions — scar tissue can form inside the abdomen after any bowel surgery. Most people have no problems, but occasionally adhesions can cause discomfort or a future blockage.
• Crohn's disease returning at the join — Crohn's can cause symptomatic recurrence at or near the reconnection point in up to 30% of patients within 5 years (endoscopic changes are more common but do not always cause symptoms). This is managed with medication and regular monitoring, not necessarily further surgery.

Rare but serious

• Short bowel syndrome — if a large amount of small bowel needs to be removed, your body may find it harder to absorb enough nutrients and fluids. This is uncommon when smaller sections are removed, and you'd be supported closely by a specialist nutrition team if needed.
• Blood clot (deep vein thrombosis or pulmonary embolism) — any major surgery carries a clot risk. We reduce this with compression stockings, blood-thinning medication, and getting you moving as soon as possible.