Objective: The last decade witnessed the significant improvement in the morbidity and mortality of short gut syndrome (SGS) patients. However, still a challenge is the patient with no or ultra-short gut (<10cm, u-SGS) due to difficult management of high pancreaticobiliary output and concurrent intraabdominal catastrophe. We herein report our series of u-SGS patient managed with a concept of surgical preconditioning utilizing native colon to prepare visceral transplantation.

Patients: In 210 referrals to our center from 8/2012 to 6/2015, 31 u-SGS patients were identified.

Results: Gut reconstruction was performed in 19 patients with enterocolostomy, of which 3 patients required complex foregut reconstruction. In remaining 12 patients, colon was not used because of previous colectomy (n=10) or other reasons (n=2), and foregut drainage was established with deodeno/jejunostomy. Diarrhea following gut reconstruction was controlled to 3-5 times per day with diet modification. TPN volume was significantly decreased after gut reconstruction but not after dudeno/jujunostomy.

With preceding gut reconstruction, required transplant organs were downgraded from modified multivisceral to isolated small bowel in one patient. In 3 patients who had gut reconstruction, a segment of the colon connected to the upper gastrointestinal tract was used as an interposition visceral conduit to the proximal end of visceral allograft in order to make transplant procedure less challenging and make transplant graftectomy feasible when needed. One-year graft survival after transplant following gut reconstruction was favorable (n=9, 100 %).

Conclusion: Gut reconstruction using colon in u-SGS patients has potential to improve pre-transplant management, and technical feasibility of visceral transplantation.

CITATION INFORMATION: Fujiki M, Hashimoto K, Khanna A, Abu-Elmagd K. The Surgical Preconditioning in Patients with Ultra-Short Gut Using a Native Colonic Conduit for Anticipated Visceral Transplantation. Am J Transplant. 2016;16 (suppl 3).

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