Surgical Management of Intestinal Failure in an Intestinal Rehabilitation Program - Initial Experience
Abstracts
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Aim To audit initial experience with non transplant surgical management of intestinal failure by a multidisciplinary Intestinal Rehabilitation Program working alongside an established intestinal transplant program. Methods The IRP consists of a team of gastroenterologists, hepatologists, surgeons, dietitians, dedicated specialist nurses, psychology, psychiatry and social services. Adult and pediatric services are represented as well as general and transplant surgeons with specific interest in autologous gastrointestinal reconstruction. Records of all patients who consulted the IRP in the last year were evaluated. Results Fiftythree patients were evaluated by the IRP in the first year. There were 28 adults and 25 children. Thirty eight of the patients had short bowel syndrome as the cause for intestinal failure. 13 children and 9 adults underwent surgical procedures to improve intestinal function. Four underwent intestinal lengthening (Bianchi), including one redo of a Bianchi procedure done elsewhere that had developed multiple enteroenteric fistulae between the 2 intestinal hemiloops. Three children underwent tapering enteroplasties (including one who also had lengthening). Four children were found to have previously missed intestinal atresias. In 2 of these 4 patients, initial referral had been for combined liver intestinal transplant evaluation. Of the adults, 2 patients had reversed intestinal segments placed for high ostomy losses, and 3 patients had repair of complex enterocutaneous fistulas. Two patients died from pneumonitis and sepsis respectively. 16 of the 22 surgical patients received all their calories via TPN at the time of surgery. 8 of the 16 are completely off TPN, and another 4 have decreased TPN requirements and continue to wean. One patient has increased TPN requirements in the face of surgical complications and worsening nutritional status. In this series, 12 of the 22 patients were initially referred for intestinal transplant evaluation, in isolation or combined liver small bowel. 5 of these 12 have been weaned completely off TPN. Conclusions This initial experience suggests a role for a dedicated multi-disciplinary intestinal failure team working closely with intestinal transplant programs in improving outcomes for patients with intestinal failure. Patients with intestinal failure who appear to be failing TPN may benefit from evaluation by such teams for optimizing management and improving overall results. |
