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Surgical therapy for short bowel syndrome
1Division of General Surgery, The Hospital for Sick Children, 555 University Avenue, Rm 1526, Toronto, Ontario M5G 1X8, Canada. paul.wales@sickkids.ca
Insights
Short bowel syndrome (SBS) patients often require long-term parenteral nutrition (TPN). Surgical interventions can optimize intestinal adaptation and absorptive surface area for TPN-dependent individuals.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Surgical Nutrition
Background:
- Short bowel syndrome (SBS) leads to significant patient morbidity due to prolonged hospitalization and parenteral nutrition (TPN).
- While most infants eventually adapt and achieve TPN independence, this can take months to years.
- Persistent TPN dependency stems from factors like bowel dysmotility, bacterial overgrowth, inadequate adaptation, or extremely short bowel length.
Purpose of the Study:
- To review the physiological process of intestinal adaptation in SBS.
- To outline surgical principles and techniques for enhancing intestinal adaptation and absorptive capacity.
Main Methods:
- Review of existing literature on intestinal adaptation.
- Synthesis of surgical strategies aimed at increasing mucosal absorptive surface area.
Main Results:
- Intestinal adaptation is a complex biological process crucial for SBS patient recovery.
- Surgical interventions offer potential to improve outcomes for TPN-dependent SBS patients.
Conclusions:
- Surgical management is a viable option for select SBS patients with persistent TPN dependency.
- Optimizing intestinal adaptation through surgery can reduce long-term morbidity and improve quality of life.
Abstract:
Patients with short bowel syndrome (SBS) suffer tremendous morbidity secondary to prolonged hospitalization and chronic parenteral nutrition (TPN). Overall, the majority of infants will adapt and ultimately become independent of TPN, but this process may require many months or years. Reasons for continued TPN dependency include bowel dysmotility, bacterial overgrowth, insufficient adaptation, or very short bowel length. It is this subpopulation of patients who may benefit from surgical procedures that optimize intestinal adaptation and increase the mucosal absorptive surface area. The goal of this review article is to summarize the process of intestinal adaptation and then to outline the surgical principles and techniques available to surgeons who treat this complicated group of patients.
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