İleoçekal valvin korunmasinin baǧirsak yetmezlikli hastalarda baǧirsak uyumuna etkisi

Background: Controversy exists regarding the preservation of the ileocecal valve (ICV) on improving intestinal adaptation in patients with intestinal failure. The aim of the present study is to examine the affects of the ICV on intestinal adaptation and to determine the factors predictive of attainment of full enteral feeds (AFEF). Material and Methods: All patients referred to our institution for management of intestinal failure (1996-2004) were reviewed and divided into those with (/CV+) or without (ICV-) the ICV. Demographic and outcome variables were examined, and a regression analysis was performed to determine factors predictive of AFEF. Statistical analysis was by Chi-square, Student t-test, ANOVA and Tukey Post-Hoc (SPSS 11.0). Results: Of 190patients, 93 (49%) were ICV+. Most common diagnoses were NEC (47; 24.7%), gastroschisis (41; 21.6%), jejunoileal atresia (27; 14.7%) and volvulus (25; 13.2%). Both ICV+ and ICV- groups had similar demographics and length of small intestine (Table). Although mortality was higher in the ICV- group, ICV did not affect line infections, TPN cholestasis, TPN duration, need for SB transplant or change in body mass index. Strikingly, AFEF was not affected by the presence of ICV (ICV+: 24% vs. ICV-:17%, p=0.3), and the most predictive factor for AFEF was the length of small bowel remaining (full enteral: 63.79±12.50 cm; enteral and TPN: 34.25±4.40 cm; TPN: 26.07±3.99 cm; p=0.001). Conclusion: Our data indicate that ICV does not influence intestinal adaptation, and supports a strategy of optimizing intestinal length to achieve full enteral feeds in patients with intestinal failure.