[Indications for total parenteral nutrition or small intestine transplantation?--Prognostic factors in short bowel syndrome].

After massive intestinal resection resulting in short bowel syndrome it is often unclear if the patient will remain on total parenteral nutrition (TPN) or regain enteral autonomy. Small bowel transplantation or bowel-lengthening procedures could potentially be a therapeutic option for patients confined to life-long parenteral nutrition. Initiated early in the course of the disease this could prevent frequent serious complications of long-term parenteral nutrition. However, it is unclear which factors determine the outcome of these patients. For further information on the long-term prognosis, data of 33 patients with short bowel syndrome operated in our institution from 1982 to 1995 were retrospectively analyzed and the present status of all living patients evaluated. Gender, age or underlying disease had no influence on the adaptation of the small intestine or the duration of TPN in the surviving patients. Return to enteral autonomy mainly depended upon the length of the remaining small and large bowel. Thus the further course of the disease can be predicted and necessary measures can be taken as this information is always available at the time of initial surgery.