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Surgical Approaches to Improving Intestinal Function in the Short-Bowel Syndrome
Jon S. Thompson, MD;
Alan N. Langnas, DO
Arch Surg. 1999;134:706-711.
Hypothesis Nontransplantation surgical approaches to improve intestinal function in patients with the short-bowel syndrome have a satisfactory outcome in selected patients.
Patients Ninety adult (aged >18 years) patients with intestinal remnants shorter than 180 cm were evaluated between 1980 and 1998.
Main Outcome Measures Clinical improvement (reduction in parenteral nutrition, resolution of anatomical problems, decreased symptoms, or improved oral intake) and postoperative morbidity and mortality rates.
Results There were 17 deaths within 30 days after resection. Thirty-seven (51%) of the surviving 73 patients underwent 43 procedures to improve intestinal function. Fourteen procedures (33%) were intended to expand intestinal surface area by restoring intestinal continuity (n=10), recruiting additional length (n=3), or longitudinal lengthening (n=1). Twenty-six procedures (60%) aimed to alter intestinal function, either by relieving obstruction (n=10), repairing fistulas (n=8), slowing transit (n=4), eliminating diseased bowel (n=3), or improving motility (n=1). Three patients had stomas created to improve oral intake and relieve perianal symptoms. Postoperatively, 2 anastomoses leaked, 2 fistulas recurred, and there was 1 death (mortality, 2%). Thirty-seven procedures (86%) resulted in clinical improvement. Eleven (46%) of the 24 patients receiving parenteral nutrition were able to discontinue it and 5 patients were able to reduce the amount of parenteral nutrition received. Twelve procedures that increased surface area (86%) and 22 procedures that addressed functional problems (85%) resulted in clinical improvement. Success was lowest (50%) in patients having procedures to prolong transit time.
Conclusions Various nontransplantation surgical procedures have a role in improving intestinal function in short-bowel syndrome. These procedures usually result in clinical improvement in properly selected patients. Success is lowest for procedures designed to prolong intestinal transit time; thus, these procedures should be used only in carefully selected patients.
From the Department of Surgery, University of Nebraska Medical Center (Drs Thompson and Langnas) and the Omaha Veterans Affairs Medical Center (Dr Thompson), Omaha.
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Invited Critique: Surgical Approaches to Improving Intestinal Function in the Short-Bowel Syndrome
Stanley J. Dudrick
Arch Surg. 1999;134(7):711.
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