title: Surgical approach to complicated intestinal failure for benign disease in adult patients: transplantation or surgical rehabilitation?
abstract: Surgical approaches to complicated benign intestinal failure are gaining acceptance, especially in the pediatric population. Less international experience has been obtained in adult patients, who are usually treated with total parenteral nutrition (TPN). An intestinal rehabilitation program was started in our institution with comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. Among 38 adult patients referred by our gastroenterologists for bowel rehabilitation and surgically treated in our institution, 92.2% received TPN on admission. After careful evaluation, 71% underwent transplantation. Five patients died, but 18 recipients were completely weaned off TPN at follow-up. Eleven patients underwent surgical resection of the affected bowel and a subsequent program of intestinal rehabilitation: they were all alive and weaned off TPN at discharge. At a 2-year mean follow-up, deaths occurred only in the transplant population. Therefore, intestinal surgical rescue, if successful, is optimal in adult patients.
authors.affiliation: UO Chirurgia dei Trapianti di Fegato e Multiorgano, University of Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.forename: L
authors.initials: L
authors.lastname: Golfieri
authors.forename: A
authors.initials: A
authors.lastname: Amaduzzi
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: A
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: G L
authors.initials: GL
authors.lastname: Grazi
authors.forename: M
authors.initials: M
authors.lastname: Vivarelli
authors.forename: G
authors.initials: G
authors.lastname: Varotti
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: M
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: F
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.forename: G
authors.initials: G
authors.lastname: La Barba
authors.forename: G
authors.initials: G
authors.lastname: Vetrone
authors.forename: M
authors.initials: M
authors.lastname: Zanello
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.forename: S
authors.initials: S
authors.lastname: Faenza
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D013505:Digestive System Surgical Procedures / Q000401:mortality / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery* / Q000628:therapy; D007422:Intestines / Q000601:surgery*; D008297:Male; D010289:Parenteral Nutrition, Total; D016019:Survival Analysis; D014180:Transplantation / Q000534:rehabilitation*; D017211:Treatment Failure