The role of anatomic factors in nutritional autonomy after extensive small bowel resection

JPEN J Parenter Enteral Nutr. Jul-Aug 1996;20(4):275-80. doi: 10.1177/0148607196020004275.

Abstract

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Jejunoileal Bypass*
  • Jejunostomy*
  • Male
  • Middle Aged
  • Nutritional Status*
  • Parenteral Nutrition, Home Total*
  • Prognosis
  • Prospective Studies
  • Retrospective Studies