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State-of-the-art colorectal disease: conservative surgical management of intestinal failure in adults

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Abstract

Purpose

Intestinal failure (IF) is defined by the reduction of gut function under the minimum necessary for adequate absorption of macronutrients and/or electrolytes, requiring home parenteral nutrition (HPN) to maintain health and/or growth. Among the different causes of IF, short bowel syndrome (SBS) is one of the main causes of IF in adults. Management of IF and SBS is complex and requires a multidisciplinary approach. The aim of this study was to review the place and the modalities of conservative surgical procedures performed for IF in adults.

Results-conclusion

HPN has drastically modified the poor prognosis of these patients, leading to an overall survival around 70–75% at 5 years in patients without cancer. However, HPN is associated with life-threatening long-term complications, including liver failure and catheter-related complications, main causes of deaths for these patients. Surgery can be proposed, in order to try to reduce SBS consequences with either conservative or non-conservative procedures. Simple bowel continuity restoration should be performed as often as possible in order to wean or at least to reduce HPN. Lengthening procedures are proposed to increase the absorption surface of the remnant bowel. These procedures can be only performed on a dilated small bowel. The slowing transit time procedure is represented by segmental reversal of the small bowel. Intestinal transplantation is the last surgical option for patients with IF but is still today associated with high mortality and failure rates. Thus, conservative procedures have a major role in the surgical armentarium for patients with IF.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Mathilde Aubert, Diane Mege & Yves Panis

  2. Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, INSERM UMRS-1149, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France

    Lore Billiauws & Francisca Joly

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  1. Mathilde Aubert
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Correspondence to Yves Panis.

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Aubert, M., Mege, D., Billiauws, L. et al. State-of-the-art colorectal disease: conservative surgical management of intestinal failure in adults. Int J Colorectal Dis 36, 1597–1607 (2021). https://doi.org/10.1007/s00384-021-03863-4

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