McBride Corrigan L, Petersen Anne, Sudan Debra, Thompson Jon
Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
Am J Surg. 2006 Dec;192(6):828-32. doi: 10.1016/j.amjsurg.2006.08.052.
Short bowel syndrome (SBS) is a potential postoperative complication that is occurring with increasing frequency after bariatric procedures (BP). As long-term follow-up data are available, unusual long-term complications are being identified. Our goal was to examine the mechanisms and outcomes of patients with SBS following BP.
We retrospectively reviewed our SBS database for patients following BP and examined their demographics, indications for resection, clinical course, and outcomes.
Eleven of 265 patients had SBS following BP. Mean age was 31 years (range 23 to 45). All were female. Operative procedures included open gastric bypass (GB) (n = 6), laproscopic GB (n = 2), jejunal-ileal bypass (JIB) (n = 1), revision of JIB (n = 1), and revision of open GB (n = 1). Five patients (45%) had internal hernia (IH). Two (18%) had bowel obstructions from adhesions that resulted in multiple resections. Two had mesenteric ischemia following revision of their BP. Two had mesenteric ischemia from a hypercoaguable state. Four SBS occurred in the initial 30-day postoperative period, 4 at 1 year, and 3 at greater than 10 years. Mean residual short bowel length was 54 cm (range 11.5 to 120 cm). All patients were on parenteral nutrition (PN) on presentation. Treatment included medical and surgical management. Currently 5 patients remain PN-dependent, 2 have died, and 4 are off PN after completing interstinal rehabilitation program/small bowel transplantation.
Complications of GB can require massive small bowel resections leading to SBS. The risk does not diminish with time. Prevention of adhesions, closure of mesenteric defects, early diagnosis of internal hernias, and conservative resections for ischemia can reduce the risk.
短肠综合征（SBS）是一种潜在的术后并发症，在减重手术（BP）后出现的频率越来越高。随着长期随访数据的可得，不常见的长期并发症正在被识别出来。我们的目标是研究BP后发生SBS的患者的机制和结局。
我们回顾性分析了BP后发生SBS的患者的数据库，并检查了他们的人口统计学特征、切除指征、临床病程和结局。
265例患者中有11例在BP后发生SBS。平均年龄为31岁（范围23至45岁）。均为女性。手术方式包括开放式胃旁路术（GB）（n = 6）、腹腔镜GB（n = 2）、空肠-回肠旁路术（JIB）（n = 1）、JIB修正术（n = 1）和开放式GB修正术（n = 1）。5例患者（45%）发生内疝（IH）。2例（18%）因粘连导致肠梗阻，需多次切除。2例在BP修正术后发生肠系膜缺血。2例因高凝状态发生肠系膜缺血。4例SBS发生在术后最初30天内，4例在1年时发生，3例在超过10年时发生。平均残余短肠长度为54 cm（范围11.5至120 cm）。所有患者就诊时均接受肠外营养（PN）。治疗包括内科和外科处理。目前5例患者仍依赖PN，2例死亡，4例在完成肠道康复计划/小肠移植后停用PN。
GB的并发症可能需要大量小肠切除，导致SBS。风险不会随时间降低。预防粘连、关闭肠系膜缺损、早期诊断内疝以及对缺血进行保守切除可降低风险。
