Bowel transplant surgery

Find out what happens during the transplant operation

Key points

You will be put to sleep under a general anaesthetic while the transplant takes place
The surgery will take between 8 to 18 hours
You will be prepared for the transplant and the donated bowel will be transplanted into your tummy. Sometimes, other organs will need to be removed and other transplants might be needed
The operation can be divided into 2 stages. Removing your damaged bowel and transplanting the donated bowel

How is bowel transplant surgery performed?

A donor bowel is transplanted in the same place as your own bowel. This involves the removal of the diseased bowel and replacement with the donated organ.

The operation time varies depending on complexity of the procedure. If other organs need to be removed or transplanted, the operation will take longer. It is often between 8 to 18 hours.

The transplant team will tell you what organs they think will need to be removed, and what organs need to be transplanted. Each type of organ transplant has a different name.

Multi-visceral transplant: liver, stomach, pancreas and bowel transplant
Modified multi-visceral transplant: stomach, pancreas and bowel transplant
Liver-intestine: liver, pancreas and bowel transplant
With all of the above types of transplant, a kidney transplant may also be needed

In some patients, the transplant team may ask for X-ray doctors (radiologists) to insert a metal plug into the blood supply to your bowel just before the transplant operation starts. This is to help lower the amount of blood lost during the transplant surgery.

In general, the operation can be divided into two main stages.

First, your damaged bowel will be removed. The incision (cut) used will depend on surgeon choice and whether you need other organs removed or transplanted during the operation. Removing your own organs can be very difficult if you have had lots of bowel surgery before.
Second, the donated organ(s) are transplanted. The blood vessels supplying the bowel will be attached to the major blood vessel in your tummy, called the abdominal aorta. The blood vessel carrying blood away from your bowel can be attached to your body in different ways, depending on what other organs might need to be transplanted. The bowel will then be stitched to your own intestines so that digested food can flow through it. The transplant surgical team will explain whether the end of the intestines will be attached to your skin (called a stoma). They will also explain whether or not the stoma is expected to be temporary or permanent.

Other organs might also need to be transplanted (for example, liver, kidney, pancreas). The surgical techniques used to transplant these organs in you may be different than other patients. Your transplant team will explain this to you.

If there is a problem with the blood supply to the transplant organs then surgery will be much longer. Sometimes a part of the transplanted intestine might need to be removed if the blood supply doesn’t look good.

If there has been a lot of bleeding, or if there are other concerns, the scar in your abdomen (tummy) may not be completely closed. Gauze swabs may be left inside you to help stop any bleeding. You will need to go back for more surgery a day or two after your transplant to remove the swabs and try to close the tummy wound.

Closing your tummy wound can be difficult if you have had many operations in the past and your tummy is scarred. The transplant team will explain your treatment options.

Some things that will happen during bowel transplant surgery

You will be given a general anaesthetic

Tubes will be inserted into your body

You will have plastic tubes (lines or catheters) inserted into your neck, arms, bladder, stomach and windpipe. Before the operation, the surgical and anaesthetic teams will explain where the tubes will be placed.

A tube is passed down your mouth into your windpipe and attached to a ventilator to assist your breathing.

Another tube is passed down your nose into your stomach – this is to prevent your stomach becoming bloated during the operation. It remains in place until you are ready to eat and drink.

Small tubes (lines or drips) are inserted into your arms to enable fluid and medications to be given to you during and after the surgery.

Additional drips will be placed in the veins of your neck. These are used to give you fluid and drugs, and to monitor your condition. They remain in place until your condition is stable and you are able to drink fluid on your own.

A catheter (tube) is inserted into your bladder, which drains urine until you are awake and able to go to the toilet.

Another tube may be put through your tummy wall into the small intestine to allow feeding directly into the bowel.

Inserting tubes into you can lead to bleeding, infection, or damage to other structures such as blood vessels or nerves. These complications are rare.

You are likely to need blood transfusions during the operation

Removing your diseased bowel can be difficult and may result in a lot of blood loss. It is very common for patients to receive a blood transfusion during the operation. Your own blood that is lost can often be collected and re-circulated back into your bloodstream.

Frequent blood tests will be taken throughout the surgery to help determine how well your blood is clotting. Sometimes it is necessary to give you additional blood products (for example, plasma or platelets) to help with blood clotting.

You may need a machine to circulate your blood during the operation

Possible complications of the surgery

Bowel transplant surgery is one the biggest and most complex operations that surgeons do. It's important that you understand the possible risks, and the expected benefits.

> What are the benefits of bowel transplant surgery?

> What are the risks of bowel transplant surgery?