Surgical Nutrition and Intestinal Failure

The University of Miami / Jackson Memorial Hospital Surgical Nutrition team, a surgeon-led multidisciplinary team which includes a clinical pharmacist, registered dietitian, and resident trainee, provides inpatient medical and surgical care for patients with complex gastrointestinal anatomy and inpatient consultation for enteral and parenteral nutrition (PN) support, as well as outpatient management of PN, intravenous fluids, and enteral nutrition (EN).

The Surgical Nutrition team specializes in intestinal rehabilitation of short bowel syndrome, treatment of bariatric surgery complications, surgical repair of enterocutaneous/enteroatmospheric fistulae, and advanced practice daily customized PN therapy. The median daily inpatient census is 15 patients (range 11-21), median monthly consultations are 20 (range 14-32), median monthly operative case volume is 8 (range 2-17), and median monthly clinic census is 42 (range 15-99) exclusive of telemedicine clinic visits, which are increasing in volume.

Due to our case mix, surgical critical care is an integral part of many of our patients and consults and the team is led by two critical care board-certified surgeons with expertise in managing critically ill surgical and trauma patients. The service receives consultations from the southeast United States as well as the Caribbean and follows patients who live at a distance using telemedicine technology. Dr. Byers and Dr. Yeh are both certified by the American Board of Surgery with added Qualifications in Critical Care, as well as the National Board of Nutritional Support, and Dr. Yeh is a fellow of critical care medicine (FCCM) and a fellow of the American Society for Parenteral and Enteral Nutrition (FASPEN).

Goals and Learning Objectives: At the conclusion of this fellowship, participants will be able to…

• Perform a comprehensive nutritional assessment of a malnourished and catabolic patients on the ward and in the intensive care unit and prescribe a customized enteral or parenteral nutritional plan
• Prescribe a detailed step-up approach for nutrition support and intestinal rehabilitation for patients with intestinal failure along the continuum of care from critical illness to stabilization to discharge and in the home setting. This may include medications, “nutraceuticals” (nutritional pharmaceuticals), specialized diets, enteral nutrition (EN), and parenteral nutrition (PN).
• Follow patients in the home setting and prescribe customized parenteral and enteral nutrition prescriptions based on their nutritional and metabolic needs and their intestinal function.
• Perform comprehensive evaluations of patients with enterocutaneous fistulae including bowel mapping approaches and techniques, nutritional support and enteral access approaches, and preoperative evaluation.
• Perform vascular, advanced enteral and peritoneal access and competently manage common post-operative complications.
• Perform a comprehensive pre-operative workup for a patient awaiting intestinal/multivisceral transplant and competently manage common post-operative complications.
• Develop operative expertise in complex abdominal operations that include repair of entero-cutaneous fistulae, restoration of intestinal continuity, and excision of mesh and abdominal wall reconstruction.

Prerequisites:

Physicians who have completed at least two years of general surgery residency training are eligible to apply for the Intestinal Failure Fellowship. The Fellowship accepts one candidate each year.

How To Apply:

Send a current curriculum vitae to program director: Dr. Patricia Byers.