title: Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience.
abstract: OBJECTIVE
  Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function.
  
  
  METHODS
  Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months.
  
  
  RESULTS
  Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%.
  
  
  CONCLUSIONS
  GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.
authors.affiliation: *Cleveland Clinic Foundation, Cleveland, OH †Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA ‡East Carolina University, Greenville, NC §Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Kareem M
authors.initials: KM
authors.lastname: Abu-Elmagd
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: David
authors.initials: D
authors.lastname: McMichael
authors.forename: Ajai
authors.initials: A
authors.lastname: Khanna
authors.forename: Ruy J
authors.initials: RJ
authors.lastname: Cruz
authors.forename: Neha
authors.initials: N
authors.lastname: Parekh
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: A Darlene
authors.initials: AD
authors.lastname: Koritsky
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kroh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sogawa
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kandeel
authors.forename: Jose Renan
authors.initials: JR
authors.lastname: da Cunha-Melo
authors.forename: Ezra
authors.initials: E
authors.lastname: Steiger
authors.forename: Donald
authors.initials: D
authors.lastname: Kirby
authors.forename: Laura
authors.initials: L
authors.lastname: Matarese
authors.forename: Abdullah
authors.initials: A
authors.lastname: Shatnawei
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: Richard
authors.initials: R
authors.lastname: Simmons
authors.forename: Timothy
authors.initials: T
authors.lastname: Billiar
authors.forename: John
authors.initials: J
authors.lastname: Fung
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D050110:Bariatric Surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007422:Intestines / Q000601:surgery / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome