The 2 STEP: an approach to repeating a serial transverse enteroplasty

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Short bowel syndrome (SBS) presents significant challenges in pediatric patients, often requiring intestinal lengthening procedures.
• The serial transverse enteroplasty (STEP) procedure is an established method for increasing small bowel length.
• Post-STEP dilatation can lead to complications like bacterial overgrowth and malabsorption, necessitating further intervention.

Observation:

• Two infants with SBS underwent a second STEP procedure due to progressive small bowel dilatation and feeding intolerance after initial surgery.
• The second STEP involved additional staple firings and tapering of redundant bowel segments to address the dilatation.
• Pre- and post-operative measurements documented significant increases in small bowel length following the repeat procedure.

Findings:

• The second STEP procedure successfully normalized intestinal diameter and further increased small bowel length in both patients.
• One patient experienced sustained improvement, while the other, despite improved enteral tolerance, succumbed to complications of long-term parenteral nutrition.
• This case series represents the first report of a successful second STEP application in SBS management.

Implications:

• Reapplication of the STEP procedure is a viable option for managing refractory small bowel dilatation in SBS.
• Meticulous surgical technique, including precise stapling and removal of blind-ending segments, is essential for optimal results.
• Further research is warranted to optimize the management of SBS and its associated complications.