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Clinical Nutrition

Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre

European Journal of Clinical Nutrition volume 70, pages 772–778 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Bariatric surgery for morbid obesity provides sustained weight loss. Complications of bariatric surgery include severe nutritional decline, but minimal data describing occurrence and outcome of intestinal failure (IF) exist.

Subjects/Methods:

All patients referred to one of the UK's National IF units (IFU) are prospectively entered onto a database; case notes were assessed for bariatric surgery details, IF onset, outcomes, resulting intestinal anatomy, mortality and catheter-related bloodstream infections (CRBSIs).

Results:

A total of six patients (mean referral age 54.0 years; 95% confidence interval (CI): 44.6–63.4; 5 female) were identified with IF after bariatric surgery from 457 patients (total cohort) managed on home parenteral nutrition (HPN) at the IFU between 2008 and 2014. In all, 6/6 had Roux-en-Y gastric bypass bariatric surgery. Median (range) time from index bariatric surgery to IF development was 28.7 months (1.7–106). IF aetiology was internal herniation (4/6), ischaemia (1/6) and anastomotic leak (1/6); all patients required HPN for a median of 26.4 months (15.3–34.7). CRBSI occurred on 7 occasions in 3 patients, equivalent to 1.5/1000 catheter days in these 6 compared with 0.32/1000 in the 451 IFU HPN patients during this time period. In all, 0/6 patients died, 6/6 had continuity restored in a median of 16.5 months (6.5–32.5) after IF diagnosis and 3/6 (50%) were weaned from PN by a median of 2.2 months (0.6–12.8).

Conclusions:

Bariatric surgery, an increasingly common operation, can be associated with IF necessitating long-term HPN. The cohort presented had a higher CRBSI compared with other HPN patients; more stringent approaches to catheter care may be required in this patient group, although more collective data are required.

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Authors and Affiliations

  1. Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK

    P J Allan, P Stevens, A Abraham, K Farrer, A Teubner, G Carlson & S Lal

  2. Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK

    P Paine

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  1. P J Allan
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  2. P Stevens
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  3. A Abraham
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  4. P Paine
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  5. K Farrer
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  6. A Teubner
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  7. G Carlson
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  8. S Lal
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Correspondence to P J Allan.

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Author contributions

PA, PP, PS and SL conceived the project; PA, PS, KF, AA and AT collected data; PA wrote the manuscript; PP, PS, GC and SL edited the manuscript. All authors have seen and agree with the submitted version.

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Allan, P., Stevens, P., Abraham, A. et al. Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre. Eur J Clin Nutr 70, 772–778 (2016). https://doi.org/10.1038/ejcn.2016.37

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