Multimodal Surgical Approach for Adult Patients With Chronic Intestinal Pseudo-Obstruction: Clinical and Psychosocial Long-term Outcomes

摘要

Abstract Background Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx). Methods The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition–related irreversible complications with chronic intestinal failure in CTx. Results At the end of follow-up (February 2015), 45.5% of CTx patients were alive: after transplantation, improvement in intestinal function was observed including a tendency toward recovery of oral diet (81.8%) with reduced parenteral nutrition support (36.4%) in the face of significant mortality rates and financial costs (mean, 202.000 euros), frequent hospitalization (mean, 8.8/re-admissions/patient), as well as limited effects on pain or physical wellness. Conclusions Through psychological tests, transplant recipients perceived a significant improvement of mental health and emotional state, showing that emotional factors were more affected than were functional/cognitive impairment and social interaction. Highlights ? Clinical and psychosocial outcomes after surgical treatment for chronic intestinal pseudo-obstruction in adult patients are debated. ? The main reason for surgery in adult CIPO patients is sub-occlusion; for transplantation, the main reason is parenteral nutrition–related irreversible complications with chronic intestinal failure. ? Clinically, transplanted adult CIPO patients show improvement in intestinal function including a tendency toward recovery of oral diet with reduced PN support. ? Through psychological tests, transplant recipients perceived a significant improvement of mental health and emotional state, showing that emotional factors are more affected than functional/cognitive impairment and social interaction.