Overview
Take out what is sick, preserve what is healthy.
Small bowel resection removes a diseased segment of small intestine — most often the ileum or jejunum — and reconnects the two healthy ends with a primary anastomosis. The mesentery containing the blood supply to the segment is divided along with the bowel. Most planned operations are done laparoscopically or robotically through three to five small incisions, with one incision extended just enough to deliver the bowel for the anastomosis.
Indications fall into several categories: Crohn's disease with stricture or fistula, small bowel tumors (carcinoid, GIST, adenocarcinoma, lymphoma), mesenteric ischemia with infarcted bowel, closed-loop or strangulating obstruction, Meckel's diverticulum, and chronic radiation enteritis. The approach and the length of resection depend on the disease — Crohn's surgery preserves as much length as possible, while oncologic resection takes the segment plus its draining mesentery for a proper lymph node harvest.
Who is a candidate?
Patients with Crohn's disease who have failed medical therapy, who have a stricture causing obstructive symptoms, or who have a fistula or abscess are common candidates. Patients with a small bowel tumor — including incidentally found carcinoids and GISTs — need resection with proper mesenteric lymph node harvest. Acute presentations include mesenteric ischemia with infarcted bowel, closed-loop or strangulating obstruction, perforation, and severe GI bleeding from a Meckel's diverticulum. Chronic indications include radiation enteritis with stricture and recurrent partial obstruction after prior abdominal surgery that has failed conservative management.
How we perform it
Under general anesthesia, we place three to five small ports. The bowel is run from the ligament of Treitz to the ileocecal valve to identify the diseased segment. The mesentery is divided using an energy device, taking care to preserve blood supply to the bowel we are leaving behind. The diseased segment is divided proximally and distally with a stapler. In a stapled side-to-side anastomosis the two bowel limbs are aligned and joined with two stapler loads. The common opening is closed with another stapler load or hand-sewn. We test the anastomosis for air-tightness and reassess perfusion at the staple lines. The specimen is delivered through a small extraction incision. Total operative time is typically 90 to 180 minutes.
Recovery
Most patients stay 3–6 days. We use a multimodal pain regimen — long-acting local anesthetic, scheduled non-opioid analgesics, and opioids only as needed — which speeds bowel recovery. You walk the day of surgery, advance from clear liquids to soft solids as bowel function returns over 2–4 days, and are discharged when you are tolerating diet, pain is controlled on oral medication, and bowel function has returned. You will lose weight from the operation itself — most is rebuilt within 6 weeks. Full activity returns at 4–6 weeks. We see you in clinic at 2 weeks and 6 weeks. Long-term follow-up depends on the underlying disease.
Why Florida Surgical
Small bowel surgery is unforgiving — the difference between a clean recovery and a leak is often in the technical details: how the mesentery is divided, how the anastomosis is constructed, how perfusion is judged at the staple line. Both Dr. Shaw and Dr. Decio are fellowship-trained surgeons with extensive small bowel experience across both elective Crohn's and oncologic operations and acute presentations. We do these cases laparoscopically or robotically whenever it is safe to do so, and we are honest about when an open approach is the right call.
Frequently asked questions
Can small bowel resection be done laparoscopically?
Yes — most planned small bowel resections, including for Crohn's disease, benign tumors, and stable adhesive disease, can be done laparoscopically or robotically with 3–5 small incisions. Emergency cases for perforation, severe ischemia, or hostile abdomens may still require an open approach. The decision is made based on imaging, prior surgeries, and physiologic status.
Will I have a stoma after small bowel resection?
Most small bowel resections are completed with a primary anastomosis — the two healthy ends are reconnected and no stoma is needed. A temporary ileostomy is occasionally needed in emergency surgery, when there is significant contamination, or when the bowel is too sick to anastomose safely. We discuss this risk with you before surgery.
How much small bowel can be removed safely?
The adult small intestine is 20–25 feet long. Most patients tolerate resection of several feet without nutritional consequences. Short bowel syndrome typically develops when less than about 6 feet remain, especially if the ileocecal valve is also removed. We always preserve as much length as possible — particularly the terminal ileum, which absorbs vitamin B12 and bile salts.
What is recovery like?
Most patients stay 3–6 days. Pain is well controlled with a multimodal regimen. Bowel function typically returns in 2–4 days. You advance from clear liquids to a regular diet. Walking starts the day of surgery. Full recovery to baseline activity takes 4–6 weeks, faster after laparoscopic or robotic surgery. Driving usually resumes at 2 weeks once off narcotic pain medication.
What is the risk of an anastomotic leak?
Small bowel anastomotic leak is uncommon — well under 5% in healthy elective patients, and lower than colon anastomoses because the small bowel has excellent blood supply. Risk rises in malnourished patients, in active Crohn's inflammation, in steroid users, and in emergency or septic operations. We assess each anastomosis carefully and add diverting ileostomy when leak risk is unacceptably high.