The role of anatomic factors in nutritional autonomy after extensive small bowel resection.
BACKGROUND
It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition.


METHODS
We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model.


RESULTS
Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy.


CONCLUSIONS
On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.
Carbonnel
F
F
Department of Gastroenterology, Hôpital Rothschild, Paris, France.
Cosnes
J
J
Chevret
S
S
Beaugerie
L
L
Ngô
Y
Y
Malafosse
M
M
Parc
R
R
Le Quintrec
Y
Y
Gendre
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007581:Jejunoileal Bypass; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016562:Parenteral Nutrition, Home Total; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies