title: Segmental reversal of the small bowel can end permanent parenteral nutrition dependency: an experience of 38 adults with short bowel syndrome.
abstract: OBJECTIVE
  This study aimed to assess the results of segmental reversal of the small bowel (SRSB) in patients with short bowel syndrome (SBS) who were "permanently" dependent on parenteral nutrition (PN) and to identify possible prognostic factors for weaning.
  
  
  BACKGROUND
  SRSB is a nontransplant surgical option for patients with SBS who require long-term PN. Few studies have reported outcomes in humans.
  
  
  METHODS
  : All patients who were permanently dependent on PN and underwent a SRSB between 1985 and 2010 for SBS were included. The data were retrospectively retrieved.
  
  
  RESULTS
  Thirty-eight patients underwent SRSB. The median age was 55.5 years (range, 18-76). The median length of the small bowel remnant was 49 cm (20-140), including a reversed segment of 10 cm (6-15). The median follow-up was 57.7 months (1-304). At the 5-year follow-up, 17 patients had been weaned from PN (45%). In the remaining patients, PN dependency had decreased from 7 ± 1 to 4 ± 1 days per week. The survival rate was 84%. The prognostic factors for weaning were a short time between subtotal enterectomy and SRSB (P = 0.036), a longer than typical stay in the nutrition unit (P = 0.035), and an SRSB longer than 10 cm (P = 0.024).
  
  
  CONCLUSIONS
  SRSB has a role as a conservative alternative to small bowel transplantation in patients with SBS permanently dependent on PN. With a segmental reversal of 10 to 12 cm, almost half of the patients can be expected to be weaned from PN.
authors.affiliation: Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon Hospital, Clichy, Paris VII University, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
authors.forename: Léon
authors.initials: L
authors.lastname: Maggiori
authors.forename: Olivier
authors.initials: O
authors.lastname: Corcos
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000401:mortality / Q000601:surgery*; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome