L.N. Kostyuchenko, T.A. Vasina, G.S. Mikhaylyants, A.E. Lychkova A.S. Loginov 

Moscow Clinical Research Center, Moscow 

Aim: to evaluate the possibilities of metabolic correction after extensive intestinal resections.

Patients and Methods: the study included 96 patients (47 men and 49 women) with combined extensive small bowel resection with right hemicolectomy. Metabolic condition was assessed in all patients with the help of alimentary and volitive diagnosis. The assessment of metabolic shifts was conducted according to plasma parameters and bioelectrical impedance analysis of body composition. Reparative processes were confirmed by morphological data and the results of Cathepsin L determination in serum by enzyme immunoassay.

Results: when registering electrical activity in the anastomosis zone, it was noted that the electric wave from the areas lying above the resection site "jumped" to the areas below the anastomosis site, without changing its amplitude-frequency characteristics. There was a little recovery of epithelial cells and their functions in 65–90% of patients in the long-term period (depending on the resection volume and level). In terms of up to 2 years, there were transient dyspeptic disorders, reduced working capacity, metabolic complications, whereas, in terms of more than 2 years — minor morphologically confirmed adaptations, weight stabilization. These symptoms correlated with the residual limb volume. The clinical and biochemical blood parameters were comparable with the integral characteristics reflecting the metabolic condition. Thus, 41% of patients needed metabolic correction in the group with resection less than 4 m and right hemic olectomy within less than 2 years after surgery (according to the NRS-2002 scale), and in the later period (over 2 years) — only 7%, due to the adaptive mechanisms of the digestive system. And in the group with resection of more than 4 m and right hemicolectomy, the number of patients requiring metabolic correction was significantly higher.

Conclusion: to stimulate adaptive and regenerative processes in the intestine in the structure of nutritional regimens, it is advisable to use teduglutide (GLP-2 analog). In case of inefficiency, surgical correction may be recommended.

Keywords: metabolic correction, intestinal resection, short bowel syndrome, postcolectomy syndrome, consequences of combined small bowel resections.

For citation: Kostyuchenko L.N., Vasina T.A., Mikhaylyants G.S., Lychkova A.E. Nutritional correction after extensive combined intestinal resections. RMJ. 2022;7:–21.