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A multidisciplinary approach to the treatment of intestinal failure

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Journal of Gastrointestinal Surgery

Abstract

Intestinal failure is most commonly treated by the administration of total parenteral nutrition (TPN). In some patients, however, surgical therapy may increase the ability to use the intestine for nutrition and thereby decrease the complications of TPN therapy. A multidisciplinary comprehensive intestinal failure program was initiated at the University of Nebraska Medical Center in October 2000. Here we describe the surgical approaches to patients with short bowel syndrome and the subsequent impact on the need for TPN and on survival. Fifty patients (children = 30, adults = 20) underwent surgical procedures to restore intestinal continuity (n = 5), repair enterocutaneous fistulas (n = 5), resect dysmotile or strictured/obstructed bowel segments or mesenteric desmoid tumors (n = 7), stricturoplasty (n = 2), Bianchi tapering and lengthening (n = 20), serial transverse enteroplasty (n = 8), and other operations (n = 8). Of these 50 patients, three patients did not require TPN after surgical intervention and seven had remnant small bowel anatomy that precluded TPN weaning (e.g., end duodenostomy) and were listed for transplantation or continued on full TPN support. Of the 40 remaining patients, most received the majority of calories fromTPNat the time of referral, i.e., mean calories fromTPN _ 90%. Subsequent to the surgical and medical therapy, 26 (65%) have been completely weaned off TPN. In addition, 10 had substantial decreases in their TPN requirements (i.e., from 85% of calories from TPN at onset decreased to a median 35% of required calories at most recent follow-up). Four patients remained on the same amount of TPN support. Four of the seven patients listed for transplantation underwent successful transplantation. Despite the complications of short bowel syndrome, 86% (n = 43) of the patients are alive and well at a mean follow-up of 2 years. Patient deaths occurred primarily in those listed or eligible for transplantation and were related to advanced liver disease (n = 3), gastrointestinal hemorrhage (n = 1), or line sepsis (n = 1). Two other patients died, one from influenza A infection and one from unknown cause at home, months after complete discontinuation of TPN. In this series of patients with short bowel syndrome, surgical intervention led to weaning or discontinuation of TPN support in 85% of patients. An organized multidisciplinary approach to the patient with short bowel syndrome is recommended.

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Authors and Affiliations

  1. Departments of Surgery, University of Nebraska Medical Center, Omaha, Nebraska

    Debra Sudan M.D. (Professor of Surgery), Jon Thompson M.D., Stephen Raynor M.D., Richard Gilroy M.D., Wendy Grant M.D., Jean Botha M.D. & Alan Langnas D.O.

  2. Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska

    John DiBaise hM.D.

  3. Pediatric Gastroenterology, University of Nebraska Medical Center, Omaha, Nebraska

    Clarivet Torres M.D. & Simon Horslen M.D.

Authors
  1. Debra Sudan M.D.
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  2. John DiBaise hM.D.
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  3. Clarivet Torres M.D.
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  4. Jon Thompson M.D.
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  5. Stephen Raynor M.D.
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  6. Richard Gilroy M.D.
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  7. Simon Horslen M.D.
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  8. Wendy Grant M.D.
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  9. Jean Botha M.D.
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  10. Alan Langnas D.O.
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Correspondence to Debra Sudan M.D..

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Sudan, D., DiBaise, J., Torres, C. et al. A multidisciplinary approach to the treatment of intestinal failure. J Gastrointest Surg 9, 165–177 (2005). https://doi.org/10.1016/j.gassur.2004.10.014

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