Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center
© 2018 American Society for Bariatric Surgery Background: Though intestinal failure (IF) after bariatric surgery (BS) is uncommon, its prevalence is increasing. However, data on the outcomes for these patients are limited. Objectives: To analyze the outcomes of treatment for patients with IF after B...
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th-mahidol.523552020-01-27T17:37:40Z Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center Wethit Dumronggittigule Elizabeth A. Marcus Bernard J. DuBray Robert S. Venick Erik Dutson Douglas G. Farmer VA Greater Los Angeles Healthcare System Mahidol University David Geffen School of Medicine at UCLA Medicine © 2018 American Society for Bariatric Surgery Background: Though intestinal failure (IF) after bariatric surgery (BS) is uncommon, its prevalence is increasing. However, data on the outcomes for these patients are limited. Objectives: To analyze the outcomes of treatment for patients with IF after BS. Setting: University hospital. Methods: A single-center analysis (1991–2016) of outcomes according to treatment arms established by a multidisciplinary team. Results: Twenty-five IF patients were identified (median age 45 yr). BS was 92% Roux-en-Y gastric bypass. The major cause of IF was volvulus/internal hernia (72%). Median time from BS to IF was 48 months. Treatment arms were intestinal rehabilitation (IR, n = 15), transplantation (TXP, n = 5), and parenteral nutrition (PN, n = 5). For IR, median bowel length was 60 cm. Forty-six percent ultimately discontinued PN. Twenty-seven percent were partially weaned PN and 27% failed IR. Common surgical rehabilitation was Roux-en-Y gastric bypass reversal and restoration of gastrointestinal continuity. The 5-year overall survival was 74%. For TXP, 7 patients were listed for TXP (5 initially and 2 after failed IR). Three underwent TXP, 2 isolated intestine and 1 isolated liver. Three were delisted (1 improvement and 2 death). For PN, 6 patients required long-term PN (5 initially and 1 after failed IR). Four patients are alive currently. Conclusions: IF after BS is an increasing problem facing IR centers. Internal hernia is the major cause. Surgical IR is the first-line therapy and affords the best outcome. TXP is reserved for rescuing patients who failed IR or develop PN complications. Long-term PN is suitable for patients in whom IR or TXP is impractical. 2020-01-27T10:37:40Z 2020-01-27T10:37:40Z 2019-01-01 Article Surgery for Obesity and Related Diseases. Vol.15, No.1 (2019), 98-108 10.1016/j.soard.2018.10.014 18787533 15507289 2-s2.0-85059833444 https://repository.li.mahidol.ac.th/handle/123456789/52355 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059833444&origin=inward |
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Medicine Wethit Dumronggittigule Elizabeth A. Marcus Bernard J. DuBray Robert S. Venick Erik Dutson Douglas G. Farmer Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
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© 2018 American Society for Bariatric Surgery Background: Though intestinal failure (IF) after bariatric surgery (BS) is uncommon, its prevalence is increasing. However, data on the outcomes for these patients are limited. Objectives: To analyze the outcomes of treatment for patients with IF after BS. Setting: University hospital. Methods: A single-center analysis (1991–2016) of outcomes according to treatment arms established by a multidisciplinary team. Results: Twenty-five IF patients were identified (median age 45 yr). BS was 92% Roux-en-Y gastric bypass. The major cause of IF was volvulus/internal hernia (72%). Median time from BS to IF was 48 months. Treatment arms were intestinal rehabilitation (IR, n = 15), transplantation (TXP, n = 5), and parenteral nutrition (PN, n = 5). For IR, median bowel length was 60 cm. Forty-six percent ultimately discontinued PN. Twenty-seven percent were partially weaned PN and 27% failed IR. Common surgical rehabilitation was Roux-en-Y gastric bypass reversal and restoration of gastrointestinal continuity. The 5-year overall survival was 74%. For TXP, 7 patients were listed for TXP (5 initially and 2 after failed IR). Three underwent TXP, 2 isolated intestine and 1 isolated liver. Three were delisted (1 improvement and 2 death). For PN, 6 patients required long-term PN (5 initially and 1 after failed IR). Four patients are alive currently. Conclusions: IF after BS is an increasing problem facing IR centers. Internal hernia is the major cause. Surgical IR is the first-line therapy and affords the best outcome. TXP is reserved for rescuing patients who failed IR or develop PN complications. Long-term PN is suitable for patients in whom IR or TXP is impractical. |
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VA Greater Los Angeles Healthcare System |
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VA Greater Los Angeles Healthcare System Wethit Dumronggittigule Elizabeth A. Marcus Bernard J. DuBray Robert S. Venick Erik Dutson Douglas G. Farmer |
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Article |
author |
Wethit Dumronggittigule Elizabeth A. Marcus Bernard J. DuBray Robert S. Venick Erik Dutson Douglas G. Farmer |
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Wethit Dumronggittigule |
title |
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
title_short |
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
title_full |
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
title_fullStr |
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
title_full_unstemmed |
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center |
title_sort |
intestinal failure after bariatric surgery: treatment and outcome at a single-intestinal rehabilitation and transplant center |
publishDate |
2020 |
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https://repository.li.mahidol.ac.th/handle/123456789/52355 |
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1763497590030073856 |