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Repeat surgical bowel lengthening with the STEP procedure.

Ane M Andres1, Jon Thompson, Wendy Grant

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Repeat intestinal lengthening using serial transverse enteroplasty (STEP) is feasible in humans. This procedure helped nearly half of carefully selected patients achieve enteral autonomy, avoiding parenteral nutrition and not preventing intestinal transplantation.

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Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Intestinal rehabilitation

Background:

  • Repeat intestinal lengthening feasibility is established in animals.
  • Human studies on secondary lengthening via serial transverse enteroplasty (STEP) have not yet achieved enteral autonomy.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of repeat intestinal lengthening after prior Bianchi or STEP procedures.
  • To assess patient survival, parenteral nutrition (PN) weaning, and the need for intestinal transplantation following repeat lengthening.

Main Methods:

  • Retrospective review of a single-center series of patients undergoing repeat intestinal lengthening.
  • Procedures included repeat serial transverse enteroplasty (STEP) after prior Bianchi or STEP.
  • Outcome measures: survival, PN weaning, and intestinal transplantation.

Main Results:

  • Repeat STEP was performed 16 times in 14 patients (2 adults, 7 male).
  • 100% survival with a median follow-up of 14.5 months.
  • 43% (6/14) of patients achieved parenteral nutrition discontinuation post-reSTEP; 4 patients required intestinal transplant salvage, all subsequently weaned off PN.

Conclusions:

  • Repeat intestinal lengthening is technically feasible following Bianchi or STEP procedures.
  • In select patients unable to wean from PN, repeat lengthening achieved TPN discontinuation in nearly half.
  • Repeat lengthening does not preclude subsequent intestinal transplantation.