Comparison of massive vs. repeated resection leading to short bowel syndrome

Short bowel syndrome can result from either a single massive intestinal res ection or repeated lesser resections, which might have prognostic implicati ons. The aim of this study was to compare patient populations and outcome o f short bowel syndrome caused by massive and repeated resection. The record s of 95 adult patients with short bowel syndrome evaluated over a 20-year p eriod were reviewed. Massive resection was performed in 72 patients (76%) a nd repeated lesser resections in 23 patients (24%). Patients undergoing mas sive resection were more likely to be more than 70 years of age (26% vs. 9% , P <0.05). Mesenteric vascular disease was more prevalent among patients u ndergoing massive resection (39% vs. 9%, P <0.05), whereas Crohn's disease was less prevalent (1% vs. 35%, p <0.05). Distribution of remnant length, p resence of the ileocecal junction, and presence of a stoma were similar. Pa tients undergoing massive resection were more likely to require parenteral nutrition after the first year (56% vs. 23%, P <0.05). Patients with very s hort remnants (<60 cm) were more likely to receive parenteral nutrition aft er massive resection (95% vs. 60%, P <0.05). Thirty-day mortality was highe r after massive re section (24% vs. 4%, P <0.05). However, those surviving 30 days had similar survival rates at I year and 5 years after massive and repeated resections. Patients undergoing massive vs. repeated resections ar e different with respect to age, underlying condition, and nutritional supp ort needs. These factors may influence overall outcome in short bowel syndr ome. The better nutritional pro,prognosis of patients undergoing repeated r esection given similar intestinal remnants may be related in part to enhanc ed intestinal adaptation.