FUNCTIONAL ADAPTATION AFTER EXTENSIVE SMALL-BOWEL RESECTION IN HUMANS

Objective: To assess the functional adaptation of the digestive remnant after extensive small bowel resection. Methods: A total of 50 patients who had had an extensive small bowel resection (residual small intestine 26-150 cm, median 70 cm) were studied longitudinally. None had chronic digestive disease. Early adaptation was assessed by following the evolution of faecal weight during the enteral refeeding period (first 3 months after surgery) in 34 patients, 19 of whom had a jejunostomy. Long-term adaptation was studied in 42 patients (all but one had intestinal continuity) followed for 13-248 months (median 87 months). Serial faecal analyses under the same dietary conditions were performed in 22 patients. Results: During the early period, faecal weight varied mainly in relation to enteral caloric intake. If one considers the period of caloric plateau only, which lasted 25 days on average, faecal weight decreased significantly (mean 9.5%). After discharge, the incidence of diarrhoea and abdominal discomfort did not change with time; most patients returned to a normal diet and their body weight and serum albumin levels increased. Faecal weight and excretion of fat and nitrogen remained unchanged, but faecal sodium levels diminished significantly. Conclusions: Functional adaptation occurs in humans following small bowel resection. This process appears minimal and time-limited, and is restricted to the early months after operation.