FUNCTIONAL ADAPTATION AFTER EXTENSIVE SMALL-BOWEL RESECTION IN HUMANS

Objective: To assess the functional adaptation of the digestive remnan t after extensive small bowel resection. Methods: A total of 50 patien ts who had had an extensive small bowel resection (residual small inte stine 26-150 cm, median 70 cm) were studied longitudinally. None had c hronic digestive disease. Early adaptation was assessed by following t he evolution of faecal weight during the enteral refeeding period (fir st 3 months after surgery) in 34 patients, 19 of whom had a jejunostom y. Long-term adaptation was studied in 42 patients (all but one had in testinal continuity) followed for 13-248 months (median 87 months). Se rial faecal analyses under the same dietary conditions were performed in 22 patients. Results: During the early period, faecal weight varied mainly in relation to enteral caloric intake. If one considers the pe riod of caloric plateau only, which lasted 25 days on average, faecal weight decreased significantly (mean 9.5%). After discharge, the incid ence of diarrhoea and abdominal discomfort did not change with time; m ost patients returned to a normal diet and their body weight and serum albumin levels increased. Faecal weight and excretion of fat and nitr ogen remained unchanged, but faecal sodium levels diminished significa ntly. Conclusions: Functional adaptation occurs in humans following sm all bowel resection. This process appears minimal and time-limited, an d is restricted to the early months after operation.