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Intestinal failure is a serious and life-threatening condition. Failure can result from several causes including fistulas, disease processes, and intestinal resections. In Great Britain several specialized referral centers have been organized to optimize management of and research on patients with serious intestinal failure. Common referral criteria include patients with less than 30 cm of residual small bowel, serious metabolic complications, multiple fistulas to dehisced abdominal wound, persistent intra-abdominal sepsis, and venous access complications (recurrent infections, thrombosis, and limited access). To cover many of the aspects of intestinal failure, I have assembled a prestigious, international group of physicians and surgeons who are recognized experts in their respective areas.
In the first article, Misters Kaushal and Carlson from the intestinal failure unit in Manchester discuss the management of enterocutaneous fistulas, one of the more frequent causes of intestinal failure seen by practitioners. The more challenging problem of the high-output fistula is covered by Drs. Arebi and Forbes, from St. Mark's Hospital, London. Nutrition is critical to the management of intestinal failure. Parenteral nutrition is reviewed by Drs. Cunliffe and Bowling from Nottingham, and Drs. Lloyd and Powell-Tuck from the Royal London Hospital discuss enteral feedings. For a few unfortunate patients, small bowel transplantation is the only long-term option. Mr. Pollard from St. James University in Leeds reviews the current status of this high-risk procedure.
Finally, we finish this issue with two articles that were originally planned for our Controversy issue (volume 16, number 4). Dr. Peter Marcello from the Lahey Clinic presents the positive attributes of hand-assisted laparoscopic colectomy and Drs. Singer and Abcarian from Chicago discuss the advantages of stapled hemorrhoidopexy.
The contributors have done an excellent job with these challenging topics. It is hoped that the readers will find their efforts informative, educational, and enjoyable.