Results of Surgery for Intestinal Failure

Darren M Tonkin

Ruchi TandonRobin KS Phillips

Carolynne J Vaizey

Intestinal Failure (IF)

“Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance.”

O’Keefe SJD, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short Bowel Syndrome and Intestinal Failure: Consensus Definitions and Overview.  Clin Gastroenterol Hepatol 2006; 4: 6-10.

Methods

Retrospective review of single-surgeon results at a UK National Intestinal

Failure Centre

July 2005 – December 2007

Demographics

59 patients

35 male

Median age 47 yrs

88 surgical interventions

Median follow up 268 days

Aetiology

Short bowel syndrome 15 (25.5%)

Enterocutaneous Fistula 42 (71%)

Internal fistula (Crohn’s disease) 2 (3.5%)

Short Bowel SyndromeMesenteric Ischaemia 9

Thrombophilia 3

Vasculopathy 3

Cocaine 2

Trauma 1

Volvulus 3

Crohn’s disease 3

Enterocutaneous Fistula

Post-operative 27 (64%)

Emergency 22

Elective 5

Crohn’s disease 13 (31%)

Trauma 2 (5%)

Enterocutaneous Fistula

On PresentationExisting stoma 34 (58%)

Requiring TPN 41 (70%)

Prior operations 4 (1 - 14)

Time to definitive 365 days (25 - 3,534)

surgery

Operations

Results

No. of operations 1 (1 - 4)

Post-op stay 16 days (1-

115)

ICU postoperatively 6

Off TPN post-op 23 (56%)

Permanent stomas 17 (29%)

Abdominal wall defect 9 (15%)

Post-operative Stomas

Complications

Recurrent fistulae 5 (8.5%)

Ventral hernia 12 (20%)

Post-op sepsis 6

30-day inpatient mortality 0%

Death during follow-up 2 (3.4%)

Analysis

TPN dependence reduced by 56%

Permanent stoma rate reduced by 50% Median residual small bowel length only

predictor of post-op TPN requirement

Patients off TPN = 150cm (12 - 400) Patients on TPN = 75cm (5 – 295)

p=0.036

Analysis

Colon in continuity &

Crohn’s disease

Not significant predictors of TPN requirement post-operatively

Discussion

Surgical management of IF patients is safe in setting of dedicated, high volume unit

Benefits seen in reduced TPN dependence & permanent stoma rates

Discussion Multidisciplinary approach essential

Pre-operative nutritional optimisation & control of sepsis

Defer definitive surgery at least 6 months

Abdominal wall reconstruction a challenge