[Surgical strategies in short bowel syndrome]

Management of short bowel syndrome has to be undertaken by a multidisciplinary team including gastroenterology, surgery, and nutrition, among other specialties. The final therapeutic goal is favoring intestinal adaptation by the bowel so that the patient may be weaned from parenteral nutrition. Anatomical factors influencing on adaptation are very important for deciding the best surgical option. The type of procedure will defined by age, length and functionality of the remnant bowel, the existence of intestinal dilation, the presence of bacterial overgrowth, and the presence or absence of parenteral nutrition-related complications, among others. Early closure of the stomas, if present, and correction of stenoses, if possible with stricturoplasties and with remodeling or intestinal plicature if needed, are among the basic principles of surgical management. Interventions aimed at decreasing the transit time such as the creation of valves, interposition of anti-peristaltic segments or large bowel are poorly accepted. The most accepted techniques are those elongating the bowel that may be applied only on dilated bowels. Although experience is greater with Bianchi's technique, short-term outcomes of serial transversal enteroplasty (STEP) are promising. STEP is simpler and may be applied even to previously elongated bowels by the Bianchi's technique.