SURGICAL APPROACH TO SHORT-BOWEL-SYNDROME - EXPERIENCE IN A POPULATION OF 160 PATIENTS

Objective The authors reviewed their experience with short-bowel syndr ome to define the surgical approach to this problem in 160 patients. M ethods Forty-eight adults and 112 children were evaluated over a 15-ye ar period. Results Seventy-one patients (44%) adapted to resection and took enteral nutrition alone. Forty-four patients (28%) were supporte d by parenteral nutrition (PN). Forty-five patients (28%) have had 49 surgical procedures. Fifteen patients with adequate intestinal length (>120 cm in adults) but dilated dysfunctional bowel underwent strictur oplasty (n = 4) or tapering (n = 11). Thirteen patients (87%) demonstr ated clinical improvement. Fourteen patients with shorter remnants (90 -120 cm) and rapid transit time received an artificial Valve (n = 2) o r a reversed segment (n = 1). All patients' conditions improved initia lly, but the reversed segment was revised or taken down. Fourteen pati ents with short remnants and dilated bowel underwent intestinal length ening. Twelve patients' conditions improved (86%), one underwent trans plantation, and one died. Sixteen patients with very short remnants (< 60 cm) and complications of PN underwent solitary intestine (n = 4) or combined liver-intestinal transplantation (n = 13). One-year graft su rvival was 65%. There have been five deaths. Conclusions The surgical approach to short-bowel syndrome depends on the patient's age, remnant length and caliber, intestinal function, and PN-related complications . Nontransplant procedures have a role in the treatment of selected pa tients. intestinal transplantation is emerging as a potential therapy for patients with significant PN-related complications.