Evaluation of the outcomes of short bowel syndrome and indications for intestinal transplantation.
Long-term parenteral nutrition (PN) and intestinal transplantation (IT) are life-saving therapies for patients with short bowel syndrome (SBS). However, indications and timing of these therapies are controversial. In this study we aimed to evaluate the indications for IT. Forty-two patients, each with <100 cm of small bowel, were divided into three groups according to the length of remnant: group I patients (n = 18): colon plus 50 to 100 cm of small bowel (SB); group II patients (n = 14): colon plus <50 cm of SB; and group III patients (n = 10): <50 cm of SB without colon. One-year mortality rates for groups I, II, and III were 50%, 72%, and 100%, respectively. All group I survivors developed intestinal adaptation, returning to regular oral feedings at 1 year. Interestingly, three of four surviving patients in group II developed adaptation and were fed an oral short bowel diet (SBD) at 1 year. None of the group III patients survived >1 year, dying due to multiorgan failure in the early postoperative period or from sepsis within 1 year. We conclude that patients with a very short bowel are candidates for IT when stable. If the colon is intact, however, regardless of small bowel remnant length, the patient should be given a chance to develop intestinal adaptation before making the decision for permanent PN or IT.
Atalay
F
F
Department of Gastrointestinal Surgery, Türkiye Yüksek Ihtisas Hospital, Binektasi Sokak No. 31/12, K. Esat, Ankara, Turkey.
Ozcay
N
N
Gundogdu
H
H
Orug
T
T
Gungor
A
A
Akoglu
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000601:surgery* / Q000628:therapy; D013923:Thromboembolism / Q000601:surgery; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome