Autologous gastrointestinal reconstruction

Autologous reconstruction of the gastrointestinal (GI) tract refers to the surgical modification of a patient’s own existing small or large intestine to improve overall enteral absorption. In its simplest form, this represents basic general surgical principles that include restoration of intestinal continuity, repair of enteroenteral or enterocutaneous fistulas, resection of extensively diseased bowel segments, and repair or removal of fixed intestinal strictures. With these procedures, the surgeon seeks to optimize exposure of the mucosal absorptive surface to the nutrient-laden enteric stream. Within the field of intestinal failure management, however, autologous reconstruction has, in large part, come to be defined as surgical techniques developed to deal primarily with intestinal dilation. In this chapter, we outline the theoretical goals of autologous reconstruction, the indications and process of evaluation for considering surgical options, and the various surgical options which have been described in this regard.