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Segmental Reversal of the Small Bowel Can End Permanent Parenteral Nutrition Dependency: An Experience of 38 Adults With Short Bowel Syndrome

Beyer-Berjot, Laura MD*; Joly, Francisca MD, PhD; Maggiori, Léon MD*; Corcos, Olivier MD; Bouhnik, Yoram MD, PhD; Bretagnol, Frédéric MD, PhD*; Panis, Yves MD, PhD*

doi: 10.1097/SLA.0b013e31827387f5
Original Articles From the ESA Proceedings

Objective: This study aimed to assess the results of segmental reversal of the small bowel (SRSB) in patients with short bowel syndrome (SBS) who were “permanently” dependent on parenteral nutrition (PN) and to identify possible prognostic factors for weaning.

Summary Background Data: SRSB is a nontransplant surgical option for patients with SBS who require long-term PN. Few studies have reported outcomes in humans.

Methods: All patients who were permanently dependent on PN and underwent a SRSB between 1985 and 2010 for SBS were included. The data were retrospectively retrieved.

Results: Thirty-eight patients underwent SRSB. The median age was 55.5 years (range, 18–76). The median length of the small bowel remnant was 49 cm (20–140), including a reversed segment of 10 cm (6–15). The median follow-up was 57.7 months (1–304). At the 5-year follow-up, 17 patients had been weaned from PN (45%). In the remaining patients, PN dependency had decreased from 7 ± 1 to 4 ± 1 days per week. The survival rate was 84%. The prognostic factors for weaning were a short time between subtotal enterectomy and SRSB (P = 0.036), a longer than typical stay in the nutrition unit (P = 0.035), and an SRSB longer than 10 cm (P = 0.024).

Conclusions: SRSB has a role as a conservative alternative to small bowel transplantation in patients with SBS permanently dependent on PN. With a segmental reversal of 10 to 12 cm, almost half of the patients can be expected to be weaned from PN.

This study assessed segmental reversal of the small bowel (SRSB) in short bowel syndrome. Weaning from parenteral nutrition was achieved in 45% of patients. Prognostic factors for weaning were a short time after enterectomy, a longer stay in the nutrition unit, and an SRSB longer than 10 cm.

Departments of *Colorectal Surgery

Gastroenterology and Nutrition Support, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon Hospital, Clichy, Paris VII University, France.

Reprints: Yves Panis, MD, PhD, Service de Chirurgie Colorectale, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.