THE ROLE OF ANATOMIC FACTORS IN NUTRITIONAL AUTONOMY AFTER EXTENSIVE SMALL-BOWEL RESECTION

Background: It is difficult to predict which patients with a postsurgi cal short bowel will require long-term parenteral nutrition. Methods: We performed a retrospective prognostic study for the time to home par enteral nutrition or death from malnutrition (nonautonomy), on the bas is of 103 patients with a residual short bowel of 17 to 150 cm. The in fluence of anatomic variables was summarized through the use of Cox re gression model. Results: Of the 103 patients included, 24 lost nutriti onal autonomy. Three anatomic variables were identified as having inde pendent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = . 01) promoted autonomy, whereas end jejunostomy (p = .002) increased th e risk of losing nutritional autonomy. Conclusions: On the basis of th ese results and on the relative weight of these variables, high-risk p atients for loss of nutritional autonomy were defined as those with je junoileal anastomosis and a remaining small bowel length < 35 cm, pati ents with jejunocolic anastomosis and remaining small bowel length < 6 0 cm, and patients with an end jejunostomy and remaining small bowel l ength < 115 cm. This classification was thereafter validated on a pros pective series of 32 patients.