Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery

Abstract

GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.

Chirurgische und metabolische Komplikationen nach bariatrischen Operationen – Ernährungsempfehlungen

“…Eine normale Ernährung wurde bei 83 % der überlebenden Patienten erreicht. Eine persistierende Adipositas oder erneute Gewichtszunahme fand sich bei 23 % [18].…”

Intestinales Versagen und Darmtransplantation

“…Die Klassifikation der S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin zu chronischem Darmversagen [2] und Pironi et al [4] unterteilen das Darmversagen eher nach internistischen Gesichtspunkten. Abu-Elmagd et al bietet eine chirurgische Klassifikation [5]. In ▶ Tab.…”

Results of Surgical and Medical Rehabilitation for Adult Patients With Type III Intestinal Failure in a Comprehensive Unit Today: Building a New Model to Predict Parenteral Nutrition Independency

“…glucagon like peptide (GLP) 1 and GLP-2, which have become an alternative to maximize the chances to recovery intestinal sufficiency or reduce the need for PN 16-22 9. Intestinal and multivisceral transplantation, which has been established as the last option to restore intestinal sufficiency in patients with life-threatening PN complications [23][24][25][26][27][28] One of the major medical challenges in the management of type III IF (III-IF) patients is still to find a prediction model for the long-term recovery of intestinal sufficiency. Intestinal rehabilitation-predicting factors in the hands of specialized multidisciplinary IF teams have not been revisited.…”

“…Over the last 20 years, we have witnessed the most significant evolution in different aspects of the management of IF, including: The definition of normal human intestinal length The report of the anatomical factors that play a role in the intestinal adaptation currently used to establish patients’ condition at referral and to propose the medical or surgical strategies to achieve intestinal rehabilitation or to identify patients that would continue chronically receiving PN with no probability for recovering sufficiency The standardization of clinical, functional, and pathophysiological classifications of IF The improvement of PN formulations, its administration, and the introduction of new lipid emulsions, which have reduced the frequency and the severity of liver disease The optimized management of catheters by well‐trained nurses and physicians, together with the implementation of antibiotic, ethanol, and taurolidine locks, which have been associated with a significant reduction of all catheter‐related infections The standardization of central venous access placement by specialized teams and of venous thrombosis management The improvement of surgical rehabilitation techniques, grouped as autologous gastrointestinal reconstruction surgery (AGIRS) and as intestinal lengthening procedures, such as longitudinal intestinal lengthening and tailoring, serial transverse enteroplasty, and spiral intestinal lengthening and tailoring The introduction of enterohormones, such as glucagon like peptide (GLP) 1 and GLP‐2, which have become an alternative to maximize the chances to recovery intestinal sufficiency or reduce the need for PN Intestinal and multivisceral transplantation, which has been established as the last option to restore intestinal sufficiency in patients with life‐threatening PN complications …”