Abstracts
1999 Digestive Disease Week

# 2179 COMPARISON OF MASSIVE RESECTION VERSUS REPEATED RESECTION LEADING TO THE SHORT BOWEL SYNDROME
Jon S Thompson, Univ of Nebraska Med Ctr, Omaha, NE

The short bowel syndrome can result from either a single massive intestinal resection or repeated lesser resections leading to a shortened intestinal remnant. Since different patient populations may be involved and the extent of resection influences the intestinal adaptive response, the manner of resection might have prognostic implications. The aim of this study was to compare the patient populations and outcome of short bowel syndrome caused by massive and repeated resection. METHODS: 95 adult patients with the short bowel syndrome (<180 cm remnant and malabsorptive symptoms) have been evaluated over a 20 year period. Records were reviewed to determine patient demographics, diagnosis. resection, status of intestinal remnant and nutritional outcome. RESULTS: Massive resection was performed in 72(76%) patients and repeated lesser resections in 23(24%) patients. Patients undergoing massive resection were more likely to be >70 years of age (26% vs 9%, P < .05) Mesenteric vascular disease was more prevalent among patients having massive resection (39% vs 9%, P < .05). Crohns disease was more prevalent among those undergoing lesser resections (1% vs 35%, P <.05) Distribution of remnant length (38% vs 22%, <60 cm), presence of the ileocecal junction (28% vs 22%), and presence of a stoma (63% and 52%) were similar in the two groups. Patients undergoing massive resection were more likely to require PN during the first year (78% vs 56%, P <.05) and to remain dependent on PN after the first year (56% vs 23%, P <.05). Patients with very short remnants (<60 cm) were more likely to be on PN after massive resection (95% vs 60%, P <.05). Intestinal procedures to improve intestinal function were more often performed in those undergoing repeated resection (45% vs 73%, P <.05) 30 day mortality was higher after massive resection (24% vs 4%, P <.05). However, those surviving 30 days had similar survival rates at 1 year (80% vs 91%, NS) and 5 years (73% and 91%, NS) after massive and repeated resection. CONCLUSIONS: Patients undergoing massive versus repeated resections are different with respect to age, underlying condition, and nutritional support needs. These factors may influence overall outcome in the short bowel syndrome. Patients undergoing repeated resection have a better nutritional prognosis given similar intestinal remnants. This may be related in part to differences in intestinal adaptation after massive versus repeated resection.

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