We have located links that may give you full text access.
Surgical approaches to improving intestinal function in the short-bowel syndrome.
Archives of Surgery 1999 July
HYPOTHESIS: Nontransplantation surgical approaches to improve intestinal function in patients with the short-bowel syndrome have a satisfactory outcome in selected patients.
PATIENTS: Ninety adult (aged >18 years) patients with intestinal remnants shorter than 180 cm were evaluated between 1980 and 1998.
MAIN OUTCOME MEASURES: Clinical improvement (reduction in parenteral nutrition, resolution of anatomical problems, decreased symptoms, or improved oral intake) and postoperative morbidity and mortality rates.
RESULTS: There were 17 deaths within 30 days after resection. Thirty-seven (51%) of the surviving 73 patients underwent 43 procedures to improve intestinal function. Fourteen procedures (33%) were intended to expand intestinal surface area by restoring intestinal continuity (n = 10), recruiting additional length (n = 3), or longitudinal lengthening (n = 1). Twenty-six procedures (60%) aimed to alter intestinal function, either by relieving obstruction (n = 10), repairing fistulas (n = 8), slowing transit (n = 4), eliminating diseased bowel (n = 3), or improving motility (n = 1). Three patients had stomas created to improve oral intake and relieve perianal symptoms. Postoperatively, 2 anastomoses leaked, 2 fistulas recurred, and there was 1 death (mortality, 2%). Thirty-seven procedures (86%) resulted in clinical improvement. Eleven (46%) of the 24 patients receiving parenteral nutrition were able to discontinue it and 5 patients were able to reduce the amount of parenteral nutrition received. Twelve procedures that increased surface area (86%) and 22 procedures that addressed functional problems (85%) resulted in clinical improvement. Success was lowest (50%) in patients having procedures to prolong transit time.
CONCLUSIONS: Various nontransplantation surgical procedures have a role in improving intestinal function in short-bowel syndrome. These procedures usually result in clinical improvement in properly selected patients. Success is lowest for procedures designed to prolong intestinal transit time; thus, these procedures should be used only in carefully selected patients.
PATIENTS: Ninety adult (aged >18 years) patients with intestinal remnants shorter than 180 cm were evaluated between 1980 and 1998.
MAIN OUTCOME MEASURES: Clinical improvement (reduction in parenteral nutrition, resolution of anatomical problems, decreased symptoms, or improved oral intake) and postoperative morbidity and mortality rates.
RESULTS: There were 17 deaths within 30 days after resection. Thirty-seven (51%) of the surviving 73 patients underwent 43 procedures to improve intestinal function. Fourteen procedures (33%) were intended to expand intestinal surface area by restoring intestinal continuity (n = 10), recruiting additional length (n = 3), or longitudinal lengthening (n = 1). Twenty-six procedures (60%) aimed to alter intestinal function, either by relieving obstruction (n = 10), repairing fistulas (n = 8), slowing transit (n = 4), eliminating diseased bowel (n = 3), or improving motility (n = 1). Three patients had stomas created to improve oral intake and relieve perianal symptoms. Postoperatively, 2 anastomoses leaked, 2 fistulas recurred, and there was 1 death (mortality, 2%). Thirty-seven procedures (86%) resulted in clinical improvement. Eleven (46%) of the 24 patients receiving parenteral nutrition were able to discontinue it and 5 patients were able to reduce the amount of parenteral nutrition received. Twelve procedures that increased surface area (86%) and 22 procedures that addressed functional problems (85%) resulted in clinical improvement. Success was lowest (50%) in patients having procedures to prolong transit time.
CONCLUSIONS: Various nontransplantation surgical procedures have a role in improving intestinal function in short-bowel syndrome. These procedures usually result in clinical improvement in properly selected patients. Success is lowest for procedures designed to prolong intestinal transit time; thus, these procedures should be used only in carefully selected patients.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
Perioperative echocardiographic strain analysis: what anesthesiologists should know.Canadian Journal of Anaesthesia 2024 April 11
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app