Postoperative short bowel syndrome

Jon S Thompson, John K. DiBaise, Kishore R. Iyer, Melania Yeats, Debra L. Sudan

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

BACKGROUND: Unanticipated massive resection after intraabdominal procedures is an increasing cause of short bowel syndrome (SBS). Our aim was to determine the frequency and potential mechanisms of postoperative SBS. STUDY DESIGN: We reviewed retrospectively the clinical course of 210 adult patients with SBS evaluated over a 20-year period. RESULTS: Fifty-two (25%) patients had postoperative SBS. The initial operations included colectomy (n=20), hysterectomy (n=8), appendectomy (n=5), gastric bypass (n=5), and other (n=14). Intestinal obstruction (n=38) was the most common reason for resection leading to SBS, either from adhesions (n=26) or volvulus (n=12). Postoperative intestinal ischemia led to resection in 14 patients. SBS occurred from 1 day postoperatively to years later, with 16 (30%) intestinal resections occurring within 1month. Patients undergoing resection for intestinal ischemia were more likely to undergo resection during the first month than were patients with adhesions and volvulus (86% versus 4% and 25%,respectively, p < 0.05): Patients undergoing resection for ischemia and volvulus were more likely to have remnant length <60 cm compared with those with adhesions (57% and 58% versus 23%, respectively, p < 0.05). Patients undergoing resection for adhesive obstruction were more likely to undergo multiple resections. Thirty-five (67%) patients required longterm parenteral nutrition. Seven (13%) patients died, three in the early postoperative period and four from complications of SBS. CONCLUSIONS: SBS is a potential postoperative complication of intraabdominal procedures and accounts for a considerable proportion of tertiary referrals for SBS. Surgical treatment of postoperative obstruction after common surgical procedures is the most frequent cause. Preventing adhesions, avoiding technical errors, diagnosing a potentially ischemic intestine in a timely manner, and approaching the frozen abdomen cautiously are important strategies for preventing this condition.

Original languageEnglish (US)
Pages (from-to)85-89
Number of pages5
JournalJournal of the American College of Surgeons
Volume201
Issue number1
DOIs
StatePublished - Jul 2005

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Short Bowel Syndrome
Intestinal Volvulus
Ischemia
Appendectomy
Gastric Bypass
Colectomy
Intestinal Obstruction
Parenteral Nutrition
Hysterectomy
Postoperative Period
Adhesives
Abdomen
Intestines
Referral and Consultation

ASJC Scopus subject areas

  • Surgery

Cite this

Postoperative short bowel syndrome. / Thompson, Jon S; DiBaise, John K.; Iyer, Kishore R.; Yeats, Melania; Sudan, Debra L.

In: Journal of the American College of Surgeons, Vol. 201, No. 1, 07.2005, p. 85-89.

Research output: Contribution to journalArticle

Thompson, Jon S ; DiBaise, John K. ; Iyer, Kishore R. ; Yeats, Melania ; Sudan, Debra L. / Postoperative short bowel syndrome. In: Journal of the American College of Surgeons. 2005 ; Vol. 201, No. 1. pp. 85-89.
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abstract = "BACKGROUND: Unanticipated massive resection after intraabdominal procedures is an increasing cause of short bowel syndrome (SBS). Our aim was to determine the frequency and potential mechanisms of postoperative SBS. STUDY DESIGN: We reviewed retrospectively the clinical course of 210 adult patients with SBS evaluated over a 20-year period. RESULTS: Fifty-two (25{\%}) patients had postoperative SBS. The initial operations included colectomy (n=20), hysterectomy (n=8), appendectomy (n=5), gastric bypass (n=5), and other (n=14). Intestinal obstruction (n=38) was the most common reason for resection leading to SBS, either from adhesions (n=26) or volvulus (n=12). Postoperative intestinal ischemia led to resection in 14 patients. SBS occurred from 1 day postoperatively to years later, with 16 (30{\%}) intestinal resections occurring within 1month. Patients undergoing resection for intestinal ischemia were more likely to undergo resection during the first month than were patients with adhesions and volvulus (86{\%} versus 4{\%} and 25{\%},respectively, p < 0.05): Patients undergoing resection for ischemia and volvulus were more likely to have remnant length <60 cm compared with those with adhesions (57{\%} and 58{\%} versus 23{\%}, respectively, p < 0.05). Patients undergoing resection for adhesive obstruction were more likely to undergo multiple resections. Thirty-five (67{\%}) patients required longterm parenteral nutrition. Seven (13{\%}) patients died, three in the early postoperative period and four from complications of SBS. CONCLUSIONS: SBS is a potential postoperative complication of intraabdominal procedures and accounts for a considerable proportion of tertiary referrals for SBS. Surgical treatment of postoperative obstruction after common surgical procedures is the most frequent cause. Preventing adhesions, avoiding technical errors, diagnosing a potentially ischemic intestine in a timely manner, and approaching the frozen abdomen cautiously are important strategies for preventing this condition.",
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