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The surgical management of short bowel syndrome
Edward M Barksdale1, Ala Stanford
1Intestinal Care Center, Department of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, 4A-485, Pittsburgh, PA 15213, USA. Barkem@chp.edu
Insights
Pediatric short bowel syndrome (SBS) management involves surgical interventions to improve nutrient absorption and reduce reliance on parenteral nutrition. These techniques aid intestinal adaptation, potentially enabling children to achieve nutritional autonomy.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Clinical nutrition
Background:
- Short bowel syndrome (SBS) in children stems from various congenital and acquired conditions.
- It leads to malabsorption, malnutrition, and metabolic issues, with some patients developing intestinal failure.
- Long-term parenteral nutrition is often required for these pediatric patients.
Purpose of the Study:
- This review discusses surgical techniques for managing pediatric short bowel syndrome.
- It covers indications, complications, and outcomes of these interventions.
- The goal is to explore surgical options that facilitate intestinal adaptation.
Main Methods:
- Review of existing literature on surgical management of pediatric short bowel syndrome.
- Analysis of different surgical techniques aimed at improving intestinal function.
- Evaluation of patient outcomes, including weaning from parenteral nutrition.
Main Results:
- Surgical interventions can enhance nutrient absorption by altering motility and transit time.
- These procedures may increase mucosal contact time, aiding adaptation.
- Selected pediatric patients can be weaned from parenteral nutrition support post-surgery.
Conclusions:
- Surgical management plays a crucial role in improving outcomes for children with short bowel syndrome.
- Adjunctive surgical procedures can facilitate intestinal adaptation and nutritional autonomy.
- Careful patient selection and technique are key to successful outcomes in pediatric SBS.
Abstract:
Short bowel syndrome is a clinical entity that results from a diverse group of congenital and acquired conditions in the pediatric population. The pathophysiology of this syndrome is characterized by malabsorption, malnutrition, and metabolic disturbances. The vast majority of children with this condition undergo spontaneous adaptation of the intestinal remnant and achieve enteral nutritional autonomy. However, a small portion of pediatric patients develop intestinal failure and require long-term or permanent dependence on total parenteral nutrition. These children may benefit from surgical interventions that facilitate intestinal adaptation. Such adjunctive procedures facilitate nutrient absorption by improving motility, prolonging intestinal transit, and/or increasing mucosal contact time. In selected patients, this may allow them to be weaned from parenteral nutritional support or to have it discontinued. The purpose of this review is to discuss the various surgical techniques for the management of short bowel syndrome in children, along with their indications, complications, and outcomes.