Bariatric Surgery Complications Leading to Short Bowel Syndrome and Intestinal Transplant Referral

Abstract

Introduction: Obesity is one of the most frequent chronic diseases affecting the world population. Bariatric surgery is currently the most effective treatment for severe morbid obesity achieving superior weight loss and improved results compared with conventional therapy by modifying the anatomy of the gastrointestinal tract. However, surgical interventions to treat morbid obesity may cause risk of serious complications. There are increasing reports of intestinal failure due short bowel syndrome following bariatric surgery. Objective: To present 6 cases of short bowel syndrome due to bariatric surgery complications in a single center and evaluate referral for intestinal transplantation. Method: We analyzed patient’s age, gender, type of bariatric surgery, complication that cause nutritional disability and present status of nutrition, and referral for intestinal transplantation. Results: Following bariatric procedures in outside facilities, a total of 6 patients became dependent of home parenteral nutrition (HPN). Their age ranged from 30 to 47 years. Types of bariatric surgery and its complication include jejunum-ileal bypass leading to malabsortion syndrome, Scopinaro procedure causing mesenteric ischemia, Lazarotto procedure causing intestinal torsion, Payene procedure causing Petersen hernia and Fobi-Capella in two cases causing mesenteric ischemia and Petersen hernia respectively. One of them was rehabilitated and is currently on oral diet with supplementation. Three of them developed ultra-short bowel syndrome, with remaining small bowel of 10 cm (1 case) and 15cm (2 cases) and catheter-related bloodstream infections been considered for small bowel transplantation and two of them subsequently died because infection. Conclusion: Surgical procedures to treat morbid obesity may develop long-term complications leading to intestinal failure and HPN dependency. Cases of HPN serious complications related to short bowel syndrome following bariatric surgery should be evaluated for intestinal transplantation, especially when associated catheter-related bloodstream infection, given to its high mortality.