Results of Autologous Gastrointestinal Reconstruction Surgery in Patients with Intestinal Failure Associated with Short Intestine Syndrome
Introduction: Patients with intestinal failure (IF) associated with short bowel syndrome (SBS) have high mortality due to factors such as advanced age and short residual intestinal length (RIL), studies conducted at our Hospital have identified enteral access and Enteral nutrition as factors that ma...
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| Autores principales: | , |
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| Formato: | Artículo |
| Lenguaje: | inglés |
| Publicado: |
2017
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| Materias: | |
| Acceso en línea: | Enlace permanente (DOI o Handle) |
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| Sumario: | Introduction: Patients with intestinal failure (IF) associated with short bowel syndrome (SBS) have high mortality due to factors such as advanced age and short residual intestinal length (RIL), studies conducted at our Hospital have identified enteral access and Enteral nutrition as factors that may decrease the risk of death. We believe that Autologous Gastrointestinal Reconstruction (AGIR) conditions the use of the distal intestinal segment and restore digestive physiology stimulated by enteral nutrition, avoiding prolonged periods of parenteral nutrition (PN) and reducing the risks of complications and death. Patients and Methods: Between 2011 and 2016 we had 80 adult patients with IF associated with SBS. We selected 39 patients who underwent AGIR. Two periods were compared: from 2011 to 2013 and from 2014 to 2016. The difference was the implementation of a protocol for AGIR in the second period. Results: In the first period (2011-2013), there was a greater proportion of intestinal ischemia and greater dependence on exclusive NP (practically double). In both periods AGIR was similar between SBS type II and SBS type III, likewise, the waiting time for surgery, except in the primary anastomosis (8 to 24 weeks). In addition, the same frequency was found for central venous catheter (CVC) infection (27.7 and 33.3, respectively). Mortality was lower in the second period (9.5% vs. 50%). Intestinal rehabilitation of survivors was 77.7% (7/9) in the first period and 66.6% (14/19) in the second period. The most frequent cause of death was sepsis, which was associated with CVC infection in 25.6% (10/39) and fungemia. Discussion: The high mortality of IF associated with SBS, generated the creation of the unit of intestinal failure and the implementation of protocols for its management. One of them was installed for AGIR. This significantly reduced mortality by comparing it to its historical control and the likely factors that contributed to this outcome were early enteral access and enteral nutrition reducing the risks of exclusive PN, in addition to the implementation of surgical behaviors and gestures such as intestinal anastomosis standardization, jejunal re-infusion, ileal recruitment and gastrostomy. Conclusion: We found that the implementation of a AGIR protocol in patients with IF associated with SBS reduced mortality and associated factors are: early enteral access and enteral nutrition. |
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