Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre.
Bariatric surgery for morbid obesity provides sustained weight loss. Complications of bariatric surgery include severe nutritional decline, but minimal data describing occurrence and outcome of intestinal failure (IF) exist.



All patients referred to one of the UK's National IF units (IFU) are prospectively entered onto a database; case notes were assessed for bariatric surgery details, IF onset, outcomes, resulting intestinal anatomy, mortality and catheter-related bloodstream infections (CRBSIs).



A total of six patients (mean referral age 54.0 years; 95% confidence interval (CI): 44.6-63.4; 5 female) were identified with IF after bariatric surgery from 457 patients (total cohort) managed on home parenteral nutrition (HPN) at the IFU between 2008 and 2014. In all, 6/6 had Roux-en-Y gastric bypass bariatric surgery. Median (range) time from index bariatric surgery to IF development was 28.7 months (1.7-106). IF aetiology was internal herniation (4/6), ischaemia (1/6) and anastomotic leak (1/6); all patients required HPN for a median of 26.4 months (15.3-34.7). CRBSI occurred on 7 occasions in 3 patients, equivalent to 1.5/1000 catheter days in these 6 compared with 0.32/1000 in the 451 IFU HPN patients during this time period. In all, 0/6 patients died, 6/6 had continuity restored in a median of 16.5 months (6.5-32.5) after IF diagnosis and 3/6 (50%) were weaned from PN by a median of 2.2 months (0.6-12.8).



Bariatric surgery, an increasingly common operation, can be associated with IF necessitating long-term HPN. The cohort presented had a higher CRBSI compared with other HPN patients; more stringent approaches to catheter care may be required in this patient group, although more collective data are required.
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
P J
PJ
Allan
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
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P
Stevens
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
A
A
Abraham
Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.
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P
Paine
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
K
K
Farrer
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
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A
Teubner
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
G
G
Carlson
Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
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S
Lal
D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000209:etiology*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006547:Hernia / Q000209:etiology; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000209:etiology / Q000628:therapy*; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D007511:Ischemia / Q000209:etiology; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000601:surgery*; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D006113:United Kingdom