Short bowel syndrome following bariatric surgical procedures

Background: 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. Study Design: We retrospectively reviewed our SBS database for patients following BP and examined their demographics, indications for resection, clinical course, and outcomes. Results: 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. Conclusions: 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.