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. 2013 Oct;25(10):e680-6.
doi: 10.1111/nmo.12191. Epub 2013 Jul 29.

Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases

C Sabbagh  1 , A Amiot, L Maggiori, O Corcos, F Joly, Y Panis
Affiliations

Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases

C Sabbagh et al. Neurogastroenterol Motil. 2013 Oct.

Abstract

Background: Chronic intestinal pseudo-obstruction (CIPO) is a recurrent disorder caused by intestinal dysmotility. Although, CIPO is not a surgically remediable condition, surgery is a common issue in CIPO patients. The aim of this study was to assess postoperative morbidity and mortality of patients operated on for CIPO and risk of re-operation.

Methods: Adult patients that have undergone surgery for CIPO since 1980 were included in this retrospective study using a prospective database. Postoperative morbidity, according to Clavien-Dindo classification and CIPO-related re-operation rates were evaluated with univariate and multivariate analysis.

Key results: Sixty-three patients (33 women, median age 37 [range: 15-79] years) were included. Median follow-up was 6 (0.2-28) years. Overall postoperative mortality rate was 7.9%. Overall morbidity rate was 58.2% (Clavien-Dindo ≥3 in 20.7%) leading to re-operation in 17% of cases. In multivariate analysis, major postoperative morbidity (Clavien-Dindo ≥3) was significantly increased when there was an intraoperative bowel injury (HR = 15.7 [2.4-102], P = 0.004), idiopathic CIPO (HR = 4.2 [1.5-12], P = 0.007) and emergency procedure (HR = 3 [1.3-6.8]. After the first surgery, probabilities of CIPO-related re-operation were 44%, 60%, and 66% at 1, 3, and 5 years respectively. In multivariate analysis, CIPO-related reoperation for CIPO was significantly increased when there was a major postoperative morbidity (HR = 2.1 [1.1-4.4], P = 0.040) and intraoperative bowel injury (HR = 33.1 [2-553], P = 0.015) after the first procedure.

Conclusions & inferences: The surgical management of CIPO patients was associated with high postoperative morbidity and mortality rates and frequent re-operation. Attempts should be made to avoid surgery when possible and optimize nutritional status.

Keywords: Surgery; chronic intestinal pseudo-obstruction; morbidity; reoperation.

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