SEGMENTAL REVERSAL OF THE SMALL-BOWEL AS AN ALTERNATIVE TO INTESTINALTRANSPLANTATION IN PATIENTS WITH SHORT-BOWEL SYNDROME

Objective This article reports the results of segmental reversal of th e small bowel on parenteral nutrition dependency in patients with very short bowel syndrome. Summary Background Data Segmental reversal of t he small bowel could be seen as an acceptable alternative to intestina l transplantation in patients with very short bowel syndrome deemed to be dependent on home parenteral nutrition. Methods Eight patients wit h 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 4 0 cm (range, 25 to 70 cm), including a median length of reversed segme nt of 12 cm (range, 8 to 15 cm). Five patients presented with jejunotr ansverse anastomosis, and one each with jejunorectal, jejuno left colo nic, or jejunocaecal anastomosis with left colostomy. Results There we re no postoperative deaths. Three patients were reoperated early for w ound dehiscence, acute cholecystitis, and sepsis of unknown origin. Th ree patients experienced transient intestinal obstruction, which was t reated conservatively Median follow-up was 35 months (range, 2 to 108 months). One patient died of pulmonary embolism 7 months postoperative ly. By the end of follow-up, three patients were on 100% oral nutritio n, one had fluid and electrolyte infusions only, and, in the four othe r patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition ces sation was obtained in 3 of 5 patients at 1 year and in 3 of 3 patient s at 4 years. Conclusion Segmental reversal of the small bowel could b e proposed as an alternative to intestinal transplantation in patients with short bower syndrome before the possible occurrence of parentera l nutrition-related complications, because weaning from parenteral nut rition (four patients) or reduction of the frequency ol infusions (lou r patients) was observed in the current study.