2013 - ISBTS 2013 Symposium

This page contains exclusive content for the member of the following sections: TTS, IXA, ITA. Log in to view.

Oral Communications 5

22.324 - SURGICAL APPROACH TO THE TREATMENT OF COMPLICATED INTESTINAL FAILURE IN ADULTS: ITALIAN SERIES 2000-2012

Presenter: Chiara, Zanfi, , Italy
Authors: Chiara Zanfi¹, Augusto Lauro¹, Giorgio Ercolani¹, Matteo Cescon¹, Matteo Ravaioli¹, Massimo Del Gaudio¹, Alessandro Cucchetti¹, Giacomo Frascaroli¹, Loris Pironi², Antonio Pinna¹

SURGICAL APPROACH TO THE TREATMENT OF COMPLICATED INTESTINAL FAILURE IN ADULTS: ITALIAN SERIES 2000-2012

Chiara Zanfi¹, Augusto Lauro¹, Giorgio Ercolani¹, Matteo Cescon¹, Matteo Ravaioli¹, Massimo Del Gaudio¹, Alessandro Cucchetti¹, Giacomo Frascaroli¹, Loris Pironi², Antonio Pinna¹

¹Liver and Multiorgan Transplant Unit, St Orsola University Hospital, University of Bologna, Bologna, Italy; ²Center for Chronic Intestinal Failure, St Orsola University Hospital, University of Bologna, Bologna, Italy

Objective: Intestinal rehabilitation is the process by which water, macronutrient and micronutrient digestive and absorptive autonomy is enhanced through bowel adaptation. This is best provided by a multidisciplinary approach, combining medical and surgical therapies, total parenteral nutrition (TPN) is used to support patients in the initial phase of intestinal recovery and, later, through the intestinal adaptation phase. Intestinal reconstructions are considered accepted treatment for patients developing total parenteral nutrition complications.

Methods: An adult intestinal rehabilitation program started in 2000 at our institution including medical rehabilitation, surgical bowel rescue, and transplantation. From 2000 to 2012, among 108adult patients referred for bowel rehabilitation, 48underwent 49 intestinal transplantations; 59patients underwent surgical rescue consisting in bowel resection and reconstructions or serial transverse enteroplasty. Underlying diseases were represented by short bowel syndrome, multiple strictures and cocoon syndrome; 5 patient had complete portal vein thrombosis. All patients were on TPN support, at various levels, with several life threatening complications of TPN in most cases (recurrent septicemia, loss of venous access, impairment of liver function).

Results:59.3% (35 patients) of patients underwent intestinal resection and elongation, 17% (10 patients) adhesiolyses and/or recnalization, 8.5% (5 patients) serial transverse enteroplasty (STEP); 5 patients with complete portal vein thrombosis successfully underwent isolated liver transplant with porto-caval hemitransposition technique. After a median follow-up of 1168 days (4 – 3287 days), 56 patients (95%) are alive with 1-3 and 5 year survival rates of 96.5% 92 % and 92% respectively. After surgery, 44 (78.5%) patients are completely off TPN. Causes of death (3 cases) were multiorgan failure after severe renal insufficiency, sepsis and liver failure

Conclusions:. Surgical rescue, when successful, allows intestinal recovery with low mortality,without long term immunosuppressive complications.

By viewing the material on this site you understand and accept that:

The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
The material is solely for educational purposes for qualified health care professionals.
The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
The information cannot be used as a substitute for professional care.
The information does not represent a standard of care.
No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada

Member Login