PE-8: Relation Between Surgical Procedures, Chronic Intestinal Failure and Dependency on Parenteral Support

Intestinal failure (IF) requires parenteral support (PS) substituting energy, water, and electrolytes to compensate intestinal losses and replenish deficits. Convalescence, adaptation, and reconstructive surgery facilitate PS reduction. We analyzed the effect of changes of PS on body mass index (BMI) in early adult IF. Energy, volume, and sodium content of PS and BMI were collected at the initial contact (FIRST), the time of maximal PS and BMI (MAX) and the last contact (LAST). Patients were categorized based on functional anatomy: small bowel enterostomy—group 1, jejuno-colic anastomosis—group 2. Analysis of variance was used to test the relative impact of changes in energy, volume, or sodium. Total of 50 patients were followed for 596 days. Although energy, volume, and sodium support were already high at FIRST, we increased PS to MAX, which was accompanied by a significant BMI increase. Thereafter PS could be reduced significantly, leading to a small BMI decrease in group 1, but not in group 2. Increased sodium support had a stronger impact on BMI than energy or volume. Total of 13 patients were weaned. Dynamic PS adjustments are required in the early phase of adult IF. Vigorous sodium support acts as an independent factor.

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Faculty Opinions recommendation of Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717964037.793465043 ◽

2012 ◽

Author(s):

Trevor Winter

Keyword(s):

Short Bowel Syndrome ◽

Intestinal Failure ◽

Short Bowel ◽

Parenteral Support

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Indications and outcomes of home parenteral nutrition in patients with an ileoanal pouch

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0131 ◽

2019 ◽

Vol 101 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

SM Oke ◽

J Segal ◽

SK Clark ◽

AL Hart ◽

SM Gabe

Keyword(s):

Restorative Proctocolectomy ◽

Adverse Outcome ◽

Rare Complication ◽

Intestinal Failure ◽

Ileoanal Pouch ◽

Normal Diet ◽

Adenomatous Polyposis ◽

Number Of Patients ◽

Adequate Hydration ◽

Parenteral Support

Introduction Restorative proctocolectomy is a surgical treatment for patients with medically refractory ulcerative colitis and some cases of familial adenomatous polyposis. Intestinal failure, defined as an inability to maintain adequate hydration and micronutrient balances when on a conventionally accepted normal diet, is a rare complication of restorative proctocolectomy. We describe our experience of patients with restorative proctocolectomy who have developed intestinal failure requiring parenteral support. Material and methods This was a retrospective analysis using a database of patients referred to our intestinal failure unit from January 1998 to January 2016. We analysed the records of all those patients who had restorative proctocolectomy who developed intestinal failure. Results 807 patient records analysed, 35 patients were found to have had a restorative proctocolectomy (13 male and 22 female). Ninety-one percent (n = 32) of patients developed IF as a consequence of unpredictable complications which occurred after RPC formation. Potentially predictable complications were noted in 9% (n = 3) of patients. Discussion and conclusions Most cases of intestinal failure in restorative proctocolectomy were unpredictable. In a small number of patients, accurate assessment and measurement of the small intestine may have better predicted the adverse outcome of intestinal failure allowing improved pre-operative counseling of patients.

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