European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

Abstract

Intestinal failure (IF) is a debilitating condition of inadequate nutrition due to an anatomical and/or physiological deficit of the intestine. Surgical management of patients with acute and chronic IF requires expertise to deal with technical challenges and make correct decisions. Dedicated IF units have expertise in patient selection, operative risk assessment and multidisciplinary support such as nutritional input and interventional radiology, which dramatically improve the morbidity and mortality of this complex condition and can beneficially affect the continuing dependence on parenteral nutritional support. Currently there is little guidance to bridge the gap between general surgeons and specialist IF surgeons. Fifteen European experts took part in a consensus process to develop guidance to support surgeons in the management of patients with IF. Based on a systematic literature review, statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general definition of IF surgery and organization of an IF unit, strategies to prevent IF, management of acute IF, management of wound, fistula and stoma, rehabilitation, intestinal and abdominal reconstruction, criteria for referral to a specialist unit and intestinal transplantation.

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

“…Its use has been advocated in selected patients and shown to reduced mortality ; however, the risk of developing an ECF in these patients is thought to be high and our data support this, with 24 of the 29 patients managed with a long‐term open abdomen presenting with an ECF. Current ESCP guidelines on the prevention of acute IF recommend early fascial closure to help prevent the formation of ECF and IH and the results of this study support this recommendation .…”

“…Many patients develop IF as a result of postoperative complications or ECF formation, both of which may be preventable . The incidence of ECF is poorly documented, although it is generally accepted that failure to recognize iatrogenic bowel injury, multiple reoperations within 3–6 months of index surgery and anastomotic failure are all predisposing factors to the development of this complication .…”

National prospective cohort study of the burden of acute small bowel obstruction

“…Optimization of the patient with SBO should also consider strategies to prevent or mitigate complications. Due recognition should be given to the fact that patients with SBO already have gut failure, and prevention of further compromise is essential as each additional organ failure adds 5–10 per cent to mortality rates. One in five patients had evidence of AKI at the point of admission, a rate similar to that in the overall intensive care population.…”

Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates

“…However, further data comparing different biological meshes found that meshes with additional crosslinking resulted in higher rates of infection and explanting . The recently published guidelines from the European Society of Coloproctology on surgery in patients with intestinal failure recommend the use of noncrosslinked mesh in AWR in patients with concurrent ECF repair. These data suggest that noncrosslinked mesh is comparatively safe to use in the presence of ECF, but hernia recurrence is still high.…”