Metabolic Effects of Small Bowel Reversal in Treatment of the Short Bowel Syndrome

Wilmore, Douglas W.; Johnson, C J

doi:10.1001/archsurg.1968.01340050124019

Cited by 28 publications

(4 citation statements)

References 14 publications

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“…By the end of follow-up, three patients were on 100% oral nutrition, one had fluid and electrolyte infusions only, and, in the four other patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition cessation was obtained in 3 of 5 patients at 1 year and in 3 of 3 patients at 4 years.…”

Section: Resultsmentioning

confidence: 99%

Segmental Reversal of the Small Bowel as an Alternative to Intestinal Transplantation in Patients With-Short Bowel Syndrome

Panis

Messing²,

Rivet³

et al. 1997

Annals of Surgery

148

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ObjectiveThis article reports the results of segmental reversal of the small bowel on parenteral nutrition dependency in patients with very short bowel syndrome. Summary Background DataSegmental reversal of the small bowel could be seen as an acceptable alternative to intestinal transplantation in patients with very short bowel syndrome deemed to be dependent on home parenteral nutrition. MethodsEight patients with short bowel syndrome underwent, at the time of intestinal continuity restoration, a segmental reversal of the distal (n = 7) or proximal (n = 1) small bowel. The median length of the remnant small bowel was 40 cm (range, 25 to 70 cm), including a median length of reversed segment of 12 cm (range, 8 to 15 cm). Five patients presented with jejunotransverse anastomosis, and one each with jejunorectal, jejuno left colonic, or jejunocaecal anastomosis with left colostomy. ResultsThere were no postoperative deaths. Three patients were reoperated early for wound dehiscence, acute cholecystitis, and sepsis of unknown origin. Three patients experienced transient intestinal obstruction, which was treated conservatively. Median follow-up was 35 months (range, 2 to 108 months). One patient died of pulmonary embolism 7 months postoperatively. By the end of follow-up, three patients were on 100% oral nutrition, one had fluid and electrolyte infusions only, and, in the four other patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition cessation was obtained in 3 of 5 patients at 1 year and in 3 of 3 patients at 4 years. ConclusionSegmental reversal of the small bowel could be proposed as an alternative to intestinal transplantation in patients with short bowel syndrome before the possible occurrence of 401

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Section: Resultsmentioning

confidence: 99%

Segmental Reversal of the Small Bowel as an Alternative to Intestinal Transplantation in Patients With-Short Bowel Syndrome

Panis

Messing²,

Rivet³

et al. 1997

Annals of Surgery

148

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“…In general, the results are not particularly encouraging, although individual patients with specific criteria may benefit. Operations to slow transit include segmental reversal of the small bowel, colonic interposition, construction of valves, recalculating loops, and electrical pacing of the small intestine [89][90][91][92][93][94][95][96][97][98]. Operations for lengthening the small intestine include the Bianchi procedure and the serial transverse enteroplasty procedure (STEP).…”

Section: Nontransplant Approachmentioning

confidence: 99%

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

et al. 2007

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Current management of short bowel syndrome (SBS) revolves around the use of home TPN (HPN). Complications include liver disease, catheter-related infections or occlusions, venous thrombosis, and bone disease. Patient survival with SBS on TPN is 86% and 75% at 2 and 5 years, respectively. Surgical management of SBS includes nontransplant surgeries such as serial transverse enteroplasty and reanastomosis. Small bowel transplant has become increasingly popular for management of SBS and is usually indicated when TPN cannot be continued. Posttransplant complications include graft-versus-host reaction, infections in an immunocompromised patient, vascular and biliary diseases, and recurrence of the original disease. Following intestinal-only transplants, patient and graft survival rate is 77% and 66% after 1 year. After 5 years the survival figures are 49% and 34%, respectively. Future improvements in survival and quality of life will enhance small bowel transplant as a viable treatment option for patients with SBS.

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“…About 50% of the patients regained enteral autonomy, whereas the remainder could significantly decrease the amount of parenteral nutrition [57]. Although most case reports demonstrated lasting improvement of the nutritional status, some authors reported only short-term success [60,61,62]. Expected benefits again have to be weighed against the potential risk of losing the intestinal remnant due to necrosis.…”

Section: Reversed Intestinal Segmentsmentioning

confidence: 99%

Short-bowel syndrome - surgical treatment with long-term benefit?

Heeckt¹,

Klein

Beger

2000

Langenbeck's Archives of Surgery

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Survival and management of patients with irreversible intestinal failure has been made possible by the development of total parenteral nutrition (TPN). Despite the progress of TPN severe and even fatal complications might occur. Different non-surgical and surgical therapies can be employed to either improve intestinal function or restore enteral autonomy to obviate the need for TPN. A comprehensive review of the pertinent literature on different treatment modalities for short-bowel syndrome and our own experience are presented to judge long-term benefit and make recommendations on up-to-date surgical management.

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Metabolic Effects of Small Bowel Reversal in Treatment of the Short Bowel Syndrome

Cited by 28 publications

References 14 publications

Segmental Reversal of the Small Bowel as an Alternative to Intestinal Transplantation in Patients With-Short Bowel Syndrome

Segmental Reversal of the Small Bowel as an Alternative to Intestinal Transplantation in Patients With-Short Bowel Syndrome

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

Short-bowel syndrome - surgical treatment with long-term benefit?

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