Management of Five Hundred Patients With Gut Failure at a Single Center: Surgical Innovation Versus Transplantation With a Novel Predictive Model.

Objective(s): To define the evolving role of integrative surgical management including transplantation for patients gut failure (GF).

Methods: A total of 500 patients with total parenteral nutrition-dependent catastrophic and chronic GF were referred for surgical intervention particularly transplantation and comprised the study population. With a mean age of 45 ± 17 years, 477 (95%) were adults and 23 (5%) were children.

Intestinal failure management at the Cleveland Clinic.

The Cleveland Clinic institutional guidelines for the management of intestinal failure, including long-term or home parenteral nutrition and related complications, intestinal rehabilitation, and small bowel transplantation, were reviewed. PubMed was searched for relevant articles. The search was performed in November 2008; keywords used were home parenteral nutrition, short bowel syndrome, intestinal rehabilitation, and small-bowel transplantation.

The multidisciplinary approach to the care of patients with intestinal failure at a tertiary care facility.

Intestinal failure is a complex disease state for which extensive therapy is often required. Parenteral nutrition is one of these therapies, but with its long-term use, life-threatening complications may develop. Intestinal rehabilitation to enhance intestinal absorption and function through diet and medication is another therapy that can be used in hopes of weaning parenteral nutrition and preventing malnutrition.

Short bowel syndrome.

Treatment of short bowel syndrome (SBS) is often a difficult endeavor due to the high variability among patients with SBS in regard to remaining anatomical structure and functional capacity. Research efforts to substantiate the use of existing therapies in the treatment of SBS are ongoing, with newer developments yet to be fully explored. Current therapy for SBS begins with the implementation of a modified diet based on the presence or absence of the colon.

Percentage of weight loss as a predictor of surgical risk: from the time of Hiram Studley to today.

Hiram Studley's 1936 article of research was the first publication to present a connection between preoperative weight loss and adverse postoperative outcome. Almost 70 years later, weight loss remains one of the most prominently used tools to assess nutritional status and predict surgical risk. This paper provides an overview of surgical practices at the time of Dr Studley and demonstrates Studley's unique contributions to the field of nutrition support.

Criteria for the use of recombinant human growth hormone in short bowel syndrome.

Extensive resection of the intestinal tract with resulting malabsorption is known as short bowel syndrome (SBS). Adaptation and rehabilitation of the remaining small bowel occurs spontaneously after resection and can be enhanced by diet, medications, and use of intestinal trophic factors such as recombinant human growth hormone (r-hGH). Many trials have been published on the influence of r-hGH therapy in SBS patients, with varying results.