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The Role of Anatomic Factors in Nutritional Autonomy After Extensive Small Bowel Resection

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Jacques Cosnes, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Sylvie Chevret, MD, PHD

Department of Biostatistics, Hôpital Saint Louis

Laurent Beaugerie, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Yann Ngô, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Michel Malafosse, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Rolland Parc, MD

Department of Surgery, Hôpital Saint Antoine, Paris, France

Yves Le Quintrec, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Jean Pierre Gendre, MD

Departments of Gastroenterology and Surgery, Hôpital Rothschild

Background: It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition. Methods: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model. Results: Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy. Conclusions: On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients. (Journal of Parenteral and Enteral Nutrition 20:275-280, 1996)

Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 4, 275-280 (1996)
DOI: 10.1177/0148607196020004275


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