Comprehensive surgical intestinal rescue and transplantation program in adult patients: Bologna experience.
BACKGROUND
Surgical approaches to complicated benign intestinal failure are accepted worldwide, especially in the pediatric population. Intestinal transplant surgery is thought to rescue patients in whom complications of total parenteral nutrition (TPN) develop.


OBJECTIVE
To report our experience with surgical intestinal rescue in an adult population with intestinal failure.


METHODS
An intestinal rehabilitation program initiated at our institution included comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. From 2000 to 2009, of 81 adult patients referred by our gastroenterologists for bowel rehabilitation, 42 (51,8%) underwent 43 transplantations (32 isolated intestinal grafts and 11 multivisceral grafts). Underlying diseases were primarily short-bowel syndrome, Gardner syndrome, and intestinal pseudo-obstruction. Thirty-nine patients (48,2%) underwent surgical rescue (40 cases) consisting of bowel resection, adhesiolysis, stricturoplasty, liver transplantation with portocaval hemitransposition (6 cases in 5 patients). Underlying diseases were primarily intestinal fistulas, stenosis, or perforations, short-bowel syndrome, cocoon syndrome, and complete portal thrombosis.


RESULTS
After a mean (SD) follow-up of 1043 (1016) days, in the transplantation population, 21 patients (50%) are alive, with a 1-, 3-, 5-year patient survival of 76%, 59%, and 52%, respectively, and graft survival of 66%, 54%, and 48%, respectively. After 901 (404) days in the rescue population, 32 patients (82%) are alive (2 died, and 5 were lost to follow-up); in 75%, TPN 25% was discontinued, and are receiving oral feeding with TPN support. The 1- and 3-year survival rate was 100% and 83%, respectively.


CONCLUSIONS
Deaths occurred primarily in the transplantation population. Intestinal surgical rescue, when possible, is optimal.
Zanfi
C
C
Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. nufito@libero.it
Lauro
A
A
Cescon
M
M
Dazzi
A
A
Ercolani
G
G
Grazi
G L
GL
Zanello
M
M
Vivarelli
M
M
Del Gaudio
M
M
Ravaioli
M
M
Cucchetti
A
A
Vetrone
G
G
Tuci
F
F
Di Gioia
P
P
Lazzarotto
T
T
D'Errico
A
A
Bagni
A
A
Faenza
S
S
Siniscalchi
A
A
Pironi
L
L
Pinna
A D
AD
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007410:Intestinal Diseases / Q000534:rehabilitation / Q000601:surgery*; D007418:Intestinal Pseudo-Obstruction / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D007558:Italy; D008297:Male; D010289:Parenteral Nutrition, Total; D012778:Short Bowel Syndrome / Q000601:surgery; D015996:Survival Rate; D017741:Survivors