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Published on: December 1, 2012
Serial transverse enteroplasty is associated with successful short-term outcomes in infants with short bowel syndrome
Patrick J Javid1, Heung Bae Kim, Christopher P Duggan
1Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Insights
The serial transverse enteroplasty (STEP) procedure safely increased intestinal length in infants with short bowel syndrome. Early results show improved nutrition and reduced need for parenteral nutrition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Short bowel syndrome (SBS) poses significant nutritional challenges in infants.
- The serial transverse enteroplasty (STEP) procedure is a surgical technique to lengthen the intestine.
- Previous animal studies suggested STEP improves nutritional indices in SBS.
Purpose of the Study:
- To evaluate the short-term surgical and nutritional outcomes of the STEP procedure in infants.
- To assess the safety and efficacy of STEP as an intestinal lengthening procedure in a pediatric cohort.
Main Methods:
- Retrospective review of 5 infants who underwent the STEP procedure between February 2002 and March 2004.
- Paired t tests were used to compare pre- and post-STEP nutritional and surgical parameters.
- Data analysis focused on intestinal length, perioperative complications, and nutritional status.
Main Results:
- STEP significantly increased intestinal length in all 5 patients without perioperative complications.
- Nutritional follow-up in 3 patients showed a significant increase in enteral nutrition.
- One patient was weaned from total parenteral nutrition, and another showed normalized bilirubin levels post-STEP.
Conclusions:
- The STEP procedure is a safe and effective method for intestinal lengthening in infants with short bowel syndrome.
- Early surgical and nutritional outcomes are promising, warranting further investigation.
- Long-term efficacy requires evaluation through multicenter data collection.
Background:
The serial transverse enteroplasty (STEP) has been shown to improve nutritional indices in an animal model of short bowel syndrome. The aim of this study was to review short-term surgical and nutritional outcomes in the first cohort of infants to undergo the STEP procedure at our institution.
Methods:
All patients who underwent the STEP procedure during a 26-month period from February 2002 to March 2004 were reviewed. Paired t tests were used for comparisons between values pre-STEP and post-STEP (P < .05 deemed significant). Data are expressed as mean and range.
Results:
The STEP was performed on 5 patients, including 1 newborn. The STEP was used as a primary lengthening operation in 4 patients. Intestinal length was significantly increased in all patients with 18 (10-26) stapler applications. There were no perioperative complications and no evidence of intestinal leak or obstruction on routine postoperative contrast study. Nutritional follow-up was available on 3 subjects at 17 (11-26) months post-STEP. Percentage of enteral nutrition was significantly increased in these subjects (P < .05). One subject was fully weaned from total parenteral nutrition 6 weeks after the STEP, and bilirubin in another patient with profound cholestasis who had been listed for liver-small bowel transplant normalized after the STEP. An additional patient, with established cirrhosis before operation, underwent successful liver-small bowel transplantation 8 months after intestinal lengthening.
Conclusion:
The STEP procedure is a simple bowel-lengthening procedure with promising early surgical and nutritional outcomes. Further data from a multicenter registry are needed to demonstrate its long-term efficacy.
