Intestinal Rehabilitation after autologous Gastrointestinal Reconstruction Surgery in adult patients with type III Intestinal Failure. Report after 10 years of experience at a single center.

HECTOR SOLAR MUNIZ; CONSTANZA ECHEVARRÍA; ADRIANA CRIVELLI; DIEGO RAMISCH; NESTOR PEDRAZA; AGUIRRE NICOLAS; FARINELLI, PABLO A.; HUGO PALADINI; GUILLERMO ORCE; FRANCISCO KLEIN; GABRIEL E. GONDOLESI

Congreso; CIRTA 2017; 2017

Introduction:Intestinal Failure (IF) is defined as ?the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to mantain health and/or growth?. The primary pathophysiological mechanism in adults (ad.) patients (pts) is the reduction of functional absorptive surface, either due to short gut syndrome or fistulas. The probability of weaning off parenteral nutrition (PN) has been reported to be below 50%, considering this possibility unlikely if complete weaning can not be achieve after 2 years. Those pts would benefit from an adequate anatomical evaluation and support at an specialized IF unit. We aim to present the long term results after Autologous Gastrointestinal Reconstruction Surgery (AGIRS) in a cohort of pts with type III IF (IF III) and its correlation to post surgical anatomy and post-surgical medical support. Material and Methods: a retrospective analysis of a prospective database of ad. pts with IF III, who received AGIR, from 3/2006 to 12/2016. Age, sex, primary diagnosis, pre and post surgical PN suppport, post-surgical intestinal length (a:≤50 cm; b: 51 to 99 cm and c:≥100cm, type of anatomy 1: terminal jejunostomy, 2: jejuno-colonic anastomosis, 3: jejuno-ileo-colonic anastomosis), presence of ileocecal valve (ICV); PN reduction > 2 days per week, freedom from PN and patient survival were analyzed using SPSS v.20.Results: From a total of 310 pts with IF, 208 were ad. 173 (83.17%) had IF III and 133 (77.45%) were secondary to short bowel syndrome (SBS). AGIR was offered to 71 pts; 58.57% were male, mean age: 52 ± 13 yrs. Diagnoses were: post-surgical IF, 55.71%; ischemia, 22.85%; post bariatric surgery, 5.71%; trauma, 4.28%, other: 11.43%. The whole colon and ICV was preserved in 38 pts (54.28%). Pre and post surgical PN time, post surgical intestinal length and type of post surgical anatomy, reduction and freedom from PN are shown in table 1. GroupsN (%)Pre surgical PN/daysPost surgical PN/daysReduce NPRequirementFreedom from NPat 2 yearsIntestinal Lengtha13 (18.30%)556.8±4071389±1103 #6 (46.15%)1 (7.70%) ** &b14 (19.72%)386±271649±809 ##2 (14.29%)9 (64.29%)%** &&c44 (62.86%)259±196199±523#/##3 (6.82%)37 (84.09%)**Type of Anatomy11 (1.43%)158 ± 124910±975 &/&&0 0 ?221 (29.58%)413 ± 366367±541&4 (19.04%)9 (42.86%) ?349 (69.01%)290± 205263±562&/&&6 (12.24%)38 (77.55%) ?Table 1. # p=0.002; ## p=0.007; ** p=0.001; & p=NS, && p=0.02; ? p=0.001. & 1/2 on Post-Surgical GLP-2 Therapy are TPN free; && 2/4 patients on GLP-2 therapy are TPN free. Figure 1. Overall Freedom from PN Overall freedom from PN was 83% (Figure 1). Long term pts survival was 92.5% at one year and 77% at 3 and 5 yrs, no difference was seen between groups; all deaths occur in oncological pts. Conclusions: AGIR in the context of an IF program offers an excellent therapeutic option for ad. pts to recover intestinal sufficiency. The intestinal length and type of anatomy remained as valuable variables to predict post-surgical outcomes; in patients with ultra short gut; but the availability of GLP-2, opens a new alternative to achieved post-surgical rehabilitation independently of the anatomical variables, reducing the time needed to achieve the expected PN reduction or sufficiency. Larger series are needed to prove these initial results.