2018 Volume 54 Issue 4 Pages 917-922
Purpose: To consider the strategy of surgical treatment for patients with intestinal failure (IF) by evaluating our experiences retrospectively.
Method: Eight patients with IF, who were referred to our institute as candidates for cadaveric intestinal transplantation (ITx) between April 2010 and April 2016, were included in this study. Their data were gathered from their charts and analyzed.
Results: Their primary diseases were total colon aganglionosis (n = 1), chronic idiopathic intestinal pseudo-obstruction syndrome (CIIPS) (n = 2), and short bowel syndrome (SBS) (n = 5). The causes of SBS were SMA embolization, graft loss after ITx, necrotizing enterocolitis (NEC), malrotation, and ulcerative colitis with primary sclerosing cholangitis. Two patients died of liver failure. On two patients among the remaining six, we performed enteroplasty/STEP, and four of the six were registered as candidates for ITx. On one of the registered patients, we performed ITx. On another of the candidates, we performed balloon enteroplasty for the stricture of the remaining bowel detected after being registered, and the patient was removed from the waiting list after the surgery. The remaining two are still waiting for transplantation. The lengths of the remaining intestine were less than 15 cm in the fatal cases.
Conclusion: Patients with the residual small bowel of less than 15 cm had poor outcomes owing to the acute deterioration of liver function. (1) Ultra-SBS, (2) severe IFALD, and (3) loss of access venous routes seem to be definitive factors for becoming a candidate for ITx.
