Autologous Gastro-Intestinal Reconstruction in Adult Patientswith Severe Intestinal Failure, Report of Long Term Outcomes and Its Correlation with Anatomical Predicting Factors. Report From a Single Center

HECTOR SOLAR; ADRIANA CRIVELLI ; ECHEVARRIA CONSTANZA; DIEGO RAMISH; LUIS MOULIN; FABIO NASHMAN; TUHAY GRACIELA; ORCE GUILLERMO; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Introduction:The primary pathophysiologic mechanism of intestinal failure (IF) inadult (ad.) patients (pts) is reduction of functional absorptive surfaceeither due to short gut syndrome or fistulas. The probability of weaningoff parenteral nutrition (PN) has been reported to be below 50%,considering this possibility unlikely if complete weaning can not beachieved after 2 years. Those pts. would benefit of an adequateanatomical evaluation and support at an specialized IF unit to correctlydefine timing and type of procedure as well as the appropriatemedical rehabilitation after surgery. We aim to present the long termresults after Autologous Gastro-intestinal Reconstruction (AGIR) ina cohort of pts with severe IF (sIF) and its correlation with the postsurgical anatomy evaluated at a single unit.Material and Methods:retrospective analysis of a prospective database of ad. pts with sIF,who received AGIR, from 3/2006 to 12/2014. Age, sex, primary diagnosis,pre and post surgical PN support, post-surgical intestinallength (a:≤50 cm; b: 51 to 99 cm and c:≥100cm, type of anatomy 1:terminal jejunostomy, 2: jejuno-colonic anastomosis, 3: jejuno-ileocolonicanastomosis), presence of ileocecal valve (ICV); PN reduction> 2/7 days, freedom from PN and patient survival were analyzedusing SPSS v.20.Results:From a total of 250 pts, 161 were ad. AGIR was offered to 58 pts;52% were male, mean age: 52 ± 13 yrs (range: 25-76 yrs). Diagnoseswere: post-surgical IF, 74.1%; ischemia, 15.5%; actinic enteritis,5.2%; trauma, 3.4%, other: 1.8%. The whole colon was preservedin 27 pts, and partial colon was left in 29 pts. The ICV could be preservedin 38 pts (65.5%). Pre and post surgical PN time, post surgicalintestinal length and type of post surgical anatomy, reduction andfreedom from PN are shown in table 1.Overall freedom from PN was 74% (Figure 1). Long term pts survivalwas 92.5% at one year and 77% at 3 and 5 yrs, no difference wasseen between groups; all deaths occurred in oncology pts.Conclusions:The intestinal length and type of anatomy are still valuable variablesto predict post-surgical outcomes; AGIR in the context of an IF programoffers an excellent therapeutic option to ad. pts to recover intestinalsufficiency or to reduce NP in patients with ultra short gut.References:1. Clinical Nutrition 32(2013):368-3742. Journal of Parenteral and Enteral Nutrition. Vol 38, Suppl 1. May2014. 8S-13S.3. Current Opinion Oran Transplant 2014, 19: 267-2754. Journal of Parenteral and Enteral Nutrition. Vol 37, N° 2, March2013. 201-211