title: Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases.
abstract: BACKGROUND
  Chronic intestinal pseudo-obstruction (CIPO) is a recurrent disorder caused by intestinal dysmotility. Although, CIPO is not a surgically remediable condition, surgery is a common issue in CIPO patients. The aim of this study was to assess postoperative morbidity and mortality of patients operated on for CIPO and risk of re-operation.
  
  
  METHODS
  Adult patients that have undergone surgery for CIPO since 1980 were included in this retrospective study using a prospective database. Postoperative morbidity, according to Clavien-Dindo classification and CIPO-related re-operation rates were evaluated with univariate and multivariate analysis.
  
  
  RESULTS
  Sixty-three patients (33 women, median age 37 [range: 15-79] years) were included. Median follow-up was 6 (0.2-28) years. Overall postoperative mortality rate was 7.9%. Overall morbidity rate was 58.2% (Clavien-Dindo ≥3 in 20.7%) leading to re-operation in 17% of cases. In multivariate analysis, major postoperative morbidity (Clavien-Dindo ≥3) was significantly increased when there was an intraoperative bowel injury (HR = 15.7 [2.4-102], P = 0.004), idiopathic CIPO (HR = 4.2 [1.5-12], P = 0.007) and emergency procedure (HR = 3 [1.3-6.8]. After the first surgery, probabilities of CIPO-related re-operation were 44%, 60%, and 66% at 1, 3, and 5 years respectively. In multivariate analysis, CIPO-related reoperation for CIPO was significantly increased when there was a major postoperative morbidity (HR = 2.1 [1.1-4.4], P = 0.040) and intraoperative bowel injury (HR = 33.1 [2-553], P = 0.015) after the first procedure.
  
  
  CONCLUSIONS
  The surgical management of CIPO patients was associated with high postoperative morbidity and mortality rates and frequent re-operation. Attempts should be made to avoid surgery when possible and optimize nutritional status.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, APHP, Clichy, France; University Diderot Paris 7, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: A
authors.initials: A
authors.lastname: Amiot
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.forename: O
authors.initials: O
authors.lastname: Corcos
authors.forename: F
authors.initials: F
authors.lastname: Joly
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Surgery; chronic intestinal pseudo-obstruction; morbidity; reoperation