Bowel Transplant

Bowel transplantation is a complex surgical procedure of replacing a damaged or non-functioning intestine with a new one from a donor. It is performed to treat conditions like acute or chronic intestinal failure (e.g. short bowel syndrome, severe motility disorder). Advancements in immunosuppressive regimens, surgical techniques, advanced diagnostic tools, and professional clinical management of pre- and post-transplant patients have led to improved benefits in this rare types of organ transplantation. It mainly aims to restore normal bowel function, improve quality of life, and treat severe gastrointestinal disorders. 

What is a bowel transplant?

Bowel transplantation, often known as intestinal transplantation, is a surgical process of transferring or replacing a healthy intestine from a donor to the recipient/patient who has a damaged/diseased bowel. Bowel transplantation is done in various conditions like intestinal failure, short bowel syndrome, and severe motility disorder. Bowel transplants are of three major types:

• Small intestine transplantation: It involves the transplantation of only the small intestine.
• Large intestine transplantation: It involves the transplantation of only the large intestine.
• Whole intestine transplantation: It involves the transplantation of the entire gastrointestinal tract.

The bowel or intestine is an organ of the digestive system. When the food reaches the stomach, it then enters the small intestine, which is also referred to as small bowel. The small intestine is made up of layers of tissues and muscles, where the tissues contain nerves, blood vessels, immune cells, and lymphatic glands. The small intestine is connected to the large intestine, which is also referred to as the colon. 

They are responsible for breaking up food, absorbing nutrients, and solidifying waste in the form of faeces. The small intestine is the longest portion of the entire gastrointestinal tract, which is responsible for most of the digestion of food. 

The small bowel has three sections: foregut, midgut, and hindgut. The duodenum is the foregut that is connected to the stomach and curves around the pancreas. It helps break down food with the help of hormones. Jejunum is the midgut. It helps in muscle movement to churn the food back and forth, mixing it with digestive juices. The ileum is the hindgut in the abdominal cavity where most water and nutrients are absorbed. It also protects against bacteria with the help of immune cells. The small intestine systematically breaks food down, absorbs nutrients, extracts water, and moves the food along the gastrointestinal tract. 

The procedure of bowel transplantation

Pre-transplantation procedure

In this phase, the patient is prepared for transplantation, where they undergo evaluation tests, like general health examinations, to assess the overall health by conducting blood tests, stool tests, and diagnosing tests, like CT scans, MRI, and endoscopy, to know about the severity of their condition. 

Transplantation procedure

• During the transplantation, the patient is given general anaesthesia. 
• Then, through the incision, the damaged bowel is removed, a new bowel is transplanted, and blood vessels are connected. 
• The surgery is performed through the stoma, which is a surgically created opening in the small intestine that allows the surgeon to monitor the transplanted organ. 
• When the transplanted organ fits and starts functioning normally, the stoma is surgically closed by the surgeons. 
• With the help of a gastrojejunostomy feeding tube, which is inserted during the surgery to the gastrointestinal tract, medications and nutrition are supplied. This tube decompresses the stomach. After recovery, it is surgically removed. 
• This whole transplantation surgery may take about 8-16 hours. 

Post-transplantation procedure

• After the transplantation surgery, you are closely monitored by the surgeons in the intensive care unit until you are stabilised.
• You are given many medications including immunosuppression to get the transplanted organ back to normal function.
• You will be advised about various diet and nutritional plans from the doctors or surgeons to help you recover as quickly as possible. 

Who requires a bowel transplant?

Bowel transplant is required by individuals, which may be children, adults, or elders, suffering from various chronic or acute intestinal disorders. Some of the conditions that require bowel transplants are as follows:

Inflammatory bowel disease (IBD)

IBD is a chronic inflammation in the gastrointestinal tract. It is a lifelong illness with no permanent treatment. The symptoms are sometimes mild or severe. They include lower abdominal pain, blood in stool, chronic diarrhoea, tiredness, and weight loss. IBD is of two kinds: 

• Crohn’s disease: It causes ulcers and sores in the gastrointestinal tract. It mainly develops in the small intestine and the upper part of the large intestine. 
• Ulcerative colitis: It causes sores, ulcers, and swelling in the large intestine, which can later spread to the rectum and colon.

Short bowel syndrome 

It is a condition caused by malnutrition, where the small intestine cannot absorb enough nutrients and fluids due to its improper function. It is often known as short gut syndrome and is commonly seen in children. The symptoms include diarrhoea, bloating, excessive gas, underdevelopment, and fatigue. 

Intestinal pseudo-obstruction

Intestinal pseudo-obstruction is an acute paralysis of the large intestine. The large intestine is blocked or obstructed in this condition, preventing the movement of food and digestion. It is caused by a malfunction of the colon’s motor system. It is also called Ogilvie syndrome. The symptoms include abdominal distension, abdominal pain, loss of appetite, bloating, and constipation.  

Intestinal malrotation

It is an abnormality where the intestine in children does not rotate in the proper way in the abdomen. It is seen in early pregnancy. It can be asymptomatic, and the children experience an abnormal twisting of the intestine, preventing food from being digested normally. This leads to loss of blood supply to the twisted part of the intestine, resulting in abnormal digestion. It is a life-threatening condition that needs to be treated as soon as possible. The symptoms include abdominal pain, abdominal cramping, vomiting, swollen abdomen, poor appetite, infrequent bowel movement, blood in faeces, fever, and lethargy. 

Celiac disease

It is an autoimmune disorder of the gastrointestinal tract, leading to a reaction to protein and gluten in the body. Gluten triggers the immune system to generate antibodies. These released antibodies damage the small intestine or the bowel, impairing its ability to absorb nutrition from the food and leading to malnutrition. It mainly affects the small intestine, where most of the nutrients are absorbed from the food. During celiac disease, gluten in the small intestine triggers the immune system, which sends inflammatory cells and antibodies to destroy the gluten molecules. These antibodies damage the mucosal layer of the small intestine. The symptoms may include stomach pain, blotted stomach, constipation, fatty stools, weakness, cold hands, weight loss, and heavy gas. 

Benefits of bowel transplant

• A bowel transplant restores the ability of the digestive system to absorb nutrients and improves digestion. As a result, healthy growth and development can be achieved.
• It treats malnutrition, which may have occurred due to various conditions affecting the small intestine. 
• Bowel transplant reduces all types of risks and complications that might have been caused due to bowel syndromes.
• It aims to improve the overall quality of life by allowing you to eat food normally and engage in all social activities with more confidence and health.
• It improves both your physical and mental health.
• Once a bowel transplant is done and the conditions are treated, you no longer need to go to hospitals and undergo medical procedures as you will efficiently recover. 
• It reduces the frequency and duration of hospitalisation, allowing you to recover and resume your daily activities. 
• It saves and extends your life expectancy during very dangerous conditions. 
• As it is an advanced procedure, it minimises the risk of infections and other complications associated with it. 
• It improves bowel movements and allows the digestive system to function properly. 

How team Fortis helps before, during, and after a bowel transplant? 

Team Fortis is a team of healthcare professionals who play a vital role in providing better treatments during bowel transplantations.

Pre-transplantation:

• Team Fortis helps you with all the evaluation tests conducted before the surgery to assess your medical conditions.
• They plan the surgery by working in coordination with the other specialists and inform you about the condition and treatment procedures that you will undergo. 
• They also explain your family and encourage them to stay brave and support you during the surgery.
• They conduct counselling, where they provide guidance regarding the advantages and disadvantages of transplantation along with the risks and complications involved in it.
• They play a major part in matching patients with suitable bowel donors as they collaborate with the National Organ Registry and other institutions.

During transplantation:

• Surgery is carried out by experienced doctors and skilled teams at Fortis. 
• Advanced diagnostic tools and technology are used for monitoring during the surgery.
• Patient safety is the main priority.
• They work with a team of surgeons, anaesthesiologists, and gastroenterologists to ensure a smooth and safe surgical procedure. 
• They mainly aim for fewer risks and complications and monitor you very closely and precisely to achieve that aim. 

Post-transplantation:

• The team ensures comprehensive and proper care for your smooth recovery. 
• Advanced medications with fewer side effects are given to patients to increase the recovery time.
• Follow-up visits are planned on a regular basis to evaluate the patient’s condition.
• They encourage the patients to make dietary plans and consume balanced nutrition.
• They help patients by guiding them in lifestyle modifications to stay healthy.
• They help in long-term care by conducting follow-up care after the discharge of the patients to make sure their health condition is good and well. 
• They offer complete assistance and treatment during the surgery. 
• They ensure the best possible outcomes during and after the surgery and keep you safe. 

Conclusion

In summary, bowel transplantation helps treat various bowel syndromes and gastrointestinal conditions affecting your digestive system and digestion. It aims at making you feel better with fewer risks, symptoms, and complications. Although, it requires careful planning and preparation.