Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience
OBJECTIVE:Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and...
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| Veröffentlicht in: | Annals of surgery 2015-10, Vol.262 (4), p.586-601 |
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| creator | Abu-Elmagd, Kareem M Costa, Guilherme McMichael, David Khanna, Ajai Cruz, Ruy J Parekh, Neha Fujiki, Masato Hashimoto, Koji Quintini, Cristiano Koritsky, A Darlene Kroh, Matthew D Sogawa, Hiroshi Kandeel, Ahmed da Cunha-Melo, Jose Renan Steiger, Ezra Kirby, Donald Matarese, Laura Shatnawei, Abdullah Humar, Abhinav Walsh, R Matthew Schauer, Philip R Simmons, Richard Billiar, Timothy Fung, John |
| description | OBJECTIVE:Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function.
METHODS:Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months.
RESULTS:Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%.
CONCLUSIONS:GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation. |
| doi_str_mv | 10.1097/SLA.0000000000001440 |
| format | Article |
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METHODS:Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months.
RESULTS:Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%.
CONCLUSIONS:GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000001440</identifier><identifier>PMID: 26366538</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Anastomosis, Surgical ; Bariatric Surgery ; Esophagus - surgery ; Female ; Humans ; Intestinal Diseases - etiology ; Intestinal Diseases - mortality ; Intestinal Diseases - surgery ; Intestines - surgery ; Intestines - transplantation ; Male ; Middle Aged ; Obesity, Morbid - surgery ; Postoperative Complications - mortality ; Postoperative Complications - surgery ; Reconstructive Surgical Procedures - methods ; Retrospective Studies ; Stomach - surgery ; Stomach - transplantation ; Transplantation, Autologous ; Treatment Outcome</subject><ispartof>Annals of surgery, 2015-10, Vol.262 (4), p.586-601</ispartof><rights>Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3015-c5c485abcd73f285ae6b5d13a4cb6f42b602262b1639b67c59c44db3e4ff37a93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26366538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abu-Elmagd, Kareem M</creatorcontrib><creatorcontrib>Costa, Guilherme</creatorcontrib><creatorcontrib>McMichael, David</creatorcontrib><creatorcontrib>Khanna, Ajai</creatorcontrib><creatorcontrib>Cruz, Ruy J</creatorcontrib><creatorcontrib>Parekh, Neha</creatorcontrib><creatorcontrib>Fujiki, Masato</creatorcontrib><creatorcontrib>Hashimoto, Koji</creatorcontrib><creatorcontrib>Quintini, Cristiano</creatorcontrib><creatorcontrib>Koritsky, A Darlene</creatorcontrib><creatorcontrib>Kroh, Matthew D</creatorcontrib><creatorcontrib>Sogawa, Hiroshi</creatorcontrib><creatorcontrib>Kandeel, Ahmed</creatorcontrib><creatorcontrib>da Cunha-Melo, Jose Renan</creatorcontrib><creatorcontrib>Steiger, Ezra</creatorcontrib><creatorcontrib>Kirby, Donald</creatorcontrib><creatorcontrib>Matarese, Laura</creatorcontrib><creatorcontrib>Shatnawei, Abdullah</creatorcontrib><creatorcontrib>Humar, Abhinav</creatorcontrib><creatorcontrib>Walsh, R Matthew</creatorcontrib><creatorcontrib>Schauer, Philip R</creatorcontrib><creatorcontrib>Simmons, Richard</creatorcontrib><creatorcontrib>Billiar, Timothy</creatorcontrib><creatorcontrib>Fung, John</creatorcontrib><title>Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function.
METHODS:Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months.
RESULTS:Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%.
CONCLUSIONS:GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.</description><subject>Adult</subject><subject>Anastomosis, Surgical</subject><subject>Bariatric Surgery</subject><subject>Esophagus - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Intestinal Diseases - etiology</subject><subject>Intestinal Diseases - mortality</subject><subject>Intestinal Diseases - surgery</subject><subject>Intestines - surgery</subject><subject>Intestines - transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - surgery</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Retrospective Studies</subject><subject>Stomach - surgery</subject><subject>Stomach - transplantation</subject><subject>Transplantation, Autologous</subject><subject>Treatment Outcome</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUdtu1DAUtBCILoU_QMiPvKT4noS3pWoL0lZFtIB4ihzneDfgjbe-qPQ3-GKcbqEIP9jHPnPGmhmEXlJyRElbv7lcLY_IP4sKQR6hBZWsqSgV5DFalFdeiZazA_Qsxu8zpiH1U3TAFFdK8maBfi1z8s6vfY74Exg_xRSySaOfsJ4G_GWMBoJ2-CroKe6cnpK-a1of8Lme9Bq2MCXsLf5YGqWM-OuYNvgsJ3yqR5cD4KVNEPA7HUadwmjwZQ5rCLdvMSP4G-gQ5_GTnzsIhcDAc_TEahfhxf15iD6fnlwdv69WF2cfjperynBCZWWkEY3UvRlqblmpQPVyoFwL0ysrWK8IY4r1VPG2V7WRrRFi6DkIa3mtW36IXu95d8FfZ4ip285qXREJxY6O1pTVtRSKF6jYQ03wMQaw3S6MWx1uO0q6OY2upNH9n0YZe3X_Q-63MPwd-mP_A--Nd8Wj-MPlGwjdBrRLmz2fkk3Fil46X6p5k_w3OuKWpw</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Abu-Elmagd, Kareem M</creator><creator>Costa, Guilherme</creator><creator>McMichael, David</creator><creator>Khanna, Ajai</creator><creator>Cruz, Ruy J</creator><creator>Parekh, Neha</creator><creator>Fujiki, Masato</creator><creator>Hashimoto, Koji</creator><creator>Quintini, Cristiano</creator><creator>Koritsky, A Darlene</creator><creator>Kroh, Matthew D</creator><creator>Sogawa, Hiroshi</creator><creator>Kandeel, Ahmed</creator><creator>da Cunha-Melo, Jose Renan</creator><creator>Steiger, Ezra</creator><creator>Kirby, Donald</creator><creator>Matarese, Laura</creator><creator>Shatnawei, Abdullah</creator><creator>Humar, Abhinav</creator><creator>Walsh, R Matthew</creator><creator>Schauer, Philip R</creator><creator>Simmons, Richard</creator><creator>Billiar, Timothy</creator><creator>Fung, John</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201510</creationdate><title>Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience</title><author>Abu-Elmagd, Kareem M ; Costa, Guilherme ; McMichael, David ; Khanna, Ajai ; Cruz, Ruy J ; Parekh, Neha ; Fujiki, Masato ; Hashimoto, Koji ; Quintini, Cristiano ; Koritsky, A Darlene ; Kroh, Matthew D ; Sogawa, Hiroshi ; Kandeel, Ahmed ; da Cunha-Melo, Jose Renan ; Steiger, Ezra ; Kirby, Donald ; Matarese, Laura ; Shatnawei, Abdullah ; Humar, Abhinav ; Walsh, R Matthew ; Schauer, Philip R ; Simmons, Richard ; Billiar, Timothy ; Fung, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3015-c5c485abcd73f285ae6b5d13a4cb6f42b602262b1639b67c59c44db3e4ff37a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Anastomosis, Surgical</topic><topic>Bariatric Surgery</topic><topic>Esophagus - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Intestinal Diseases - etiology</topic><topic>Intestinal Diseases - mortality</topic><topic>Intestinal Diseases - surgery</topic><topic>Intestines - surgery</topic><topic>Intestines - transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - surgery</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Retrospective Studies</topic><topic>Stomach - surgery</topic><topic>Stomach - transplantation</topic><topic>Transplantation, Autologous</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abu-Elmagd, Kareem M</creatorcontrib><creatorcontrib>Costa, Guilherme</creatorcontrib><creatorcontrib>McMichael, David</creatorcontrib><creatorcontrib>Khanna, Ajai</creatorcontrib><creatorcontrib>Cruz, Ruy J</creatorcontrib><creatorcontrib>Parekh, Neha</creatorcontrib><creatorcontrib>Fujiki, Masato</creatorcontrib><creatorcontrib>Hashimoto, Koji</creatorcontrib><creatorcontrib>Quintini, Cristiano</creatorcontrib><creatorcontrib>Koritsky, A Darlene</creatorcontrib><creatorcontrib>Kroh, Matthew D</creatorcontrib><creatorcontrib>Sogawa, Hiroshi</creatorcontrib><creatorcontrib>Kandeel, Ahmed</creatorcontrib><creatorcontrib>da Cunha-Melo, Jose Renan</creatorcontrib><creatorcontrib>Steiger, Ezra</creatorcontrib><creatorcontrib>Kirby, Donald</creatorcontrib><creatorcontrib>Matarese, Laura</creatorcontrib><creatorcontrib>Shatnawei, Abdullah</creatorcontrib><creatorcontrib>Humar, Abhinav</creatorcontrib><creatorcontrib>Walsh, R Matthew</creatorcontrib><creatorcontrib>Schauer, Philip R</creatorcontrib><creatorcontrib>Simmons, Richard</creatorcontrib><creatorcontrib>Billiar, Timothy</creatorcontrib><creatorcontrib>Fung, John</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abu-Elmagd, Kareem M</au><au>Costa, Guilherme</au><au>McMichael, David</au><au>Khanna, Ajai</au><au>Cruz, Ruy J</au><au>Parekh, Neha</au><au>Fujiki, Masato</au><au>Hashimoto, Koji</au><au>Quintini, Cristiano</au><au>Koritsky, A Darlene</au><au>Kroh, Matthew D</au><au>Sogawa, Hiroshi</au><au>Kandeel, Ahmed</au><au>da Cunha-Melo, Jose Renan</au><au>Steiger, Ezra</au><au>Kirby, Donald</au><au>Matarese, Laura</au><au>Shatnawei, Abdullah</au><au>Humar, Abhinav</au><au>Walsh, R Matthew</au><au>Schauer, Philip R</au><au>Simmons, Richard</au><au>Billiar, Timothy</au><au>Fung, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2015-10</date><risdate>2015</risdate><volume>262</volume><issue>4</issue><spage>586</spage><epage>601</epage><pages>586-601</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function.
METHODS:Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months.
RESULTS:Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%.
CONCLUSIONS:GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26366538</pmid><doi>10.1097/SLA.0000000000001440</doi><tpages>16</tpages></addata></record> |
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| ispartof | Annals of surgery, 2015-10, Vol.262 (4), p.586-601 |
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| subjects | Adult Anastomosis, Surgical Bariatric Surgery Esophagus - surgery Female Humans Intestinal Diseases - etiology Intestinal Diseases - mortality Intestinal Diseases - surgery Intestines - surgery Intestines - transplantation Male Middle Aged Obesity, Morbid - surgery Postoperative Complications - mortality Postoperative Complications - surgery Reconstructive Surgical Procedures - methods Retrospective Studies Stomach - surgery Stomach - transplantation Transplantation, Autologous Treatment Outcome |
| title | Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience |
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