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Published on: December 1, 2012
Autologous intestinal reconstructive surgery to reduce bowel dilatation improves intestinal adaptation in children
Sarah L Almond1, Zeni Haveliwala, Basem Khalil
1Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK. sarah.l.almond@gmail.com
Insights
Surgical reduction of bowel diameter effectively treats intestinal failure in neonates with short bowel syndrome. This approach helps children achieve parenteral nutrition independence and may reduce the need for bowel transplantation.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Intestinal failure management
Background:
- Intestinal failure (IF) is a significant complication in neonates with small bowel pathology.
- Bowel dilatation often contributes to IF, hindering adaptation even with adequate residual bowel length.
- Current management strategies for IF in neonates with short bowel syndrome are limited.
Purpose of the Study:
- To investigate the efficacy of surgical reduction of bowel diameter in treating neonatal intestinal failure.
- To determine if surgical intervention can facilitate parenteral nutrition (PN) independence in affected children.
- To evaluate the impact of reconstructive surgery on bowel length and associated complications.
Main Methods:
- Prospective data collection over a 7-year period (2004-2011) for neonates with IF.
- Inclusion criteria: bowel dilatation, failure to adapt despite >40 cm bowel length, and total PN dependence.
- Surgical interventions included longitudinal intestinal lengthening and tailoring, serial transverse enteroplasty, and tapering enteroplasty.
Main Results:
- Mean gut length increased significantly from 51 cm to 73 cm post-surgery (P=0.02).
- Postoperative reduction in sepsis incidence (P=0.01) and peak serum bilirubin levels (P=0.005).
- Seven out of eight patients achieved PN independence after a median of 110 days.
Conclusions:
- Reconstructive surgery to reduce bowel diameter is an effective treatment for IF in short bowel syndrome patients.
- This surgical approach can facilitate PN independence without compromising intestinal length.
- The findings suggest a potential to decrease the requirement for bowel transplantation in this patient cohort.
Objectives:
Intestinal failure (IF) is a common consequence of neonatal small bowel pathology. In our experience, bowel dilatation is often responsible for the IF state in patients who fail to adapt despite adequate residual bowel length. The aim of the present study was to investigate the role of surgery to reduce bowel dilatation, and thus favour PN independence, for these children.
Methods:
Data were collected prospectively for all of the patients referred to our unit for a 7-year period (2004-2011). Eight patients (2 congenital atresia, 2 gastroschisis with atresia, 1 simple gastroschisis, 3 necrotising enterocolitis) with gut dilatation who failed adaptation despite a bowel length >40 cm were identified. Preoperatively, all patients were totally dependent on parenteral nutrition (PN). Patients were managed by longitudinal intestinal lengthening and tailoring (n = 3), serial transverse enteroplasty (n = 2), or tapering enteroplasty (n = 3).
Results:
Median age at time of surgery was 273 days (103-1059). Mean gut length increased from 51 (35-75) to 73 cm (45-120) following surgery (P = 0.02). Incidence of sepsis (P = 0.01) and peak serum bilirubin levels (P = 0.005) were reduced postoperatively. PN was discontinued after a median of 110 days (35-537) for 7 patients; 1 patient remains on PN 497 days after surgery.
Conclusions:
These data indicate that reconstructive surgery to reduce bowel diameter may be an effective technique for treating IF in patients with short bowel syndrome, without sacrificing intestinal length. We suggest that this technique may reduce the need for bowel transplantation in this group of patients.
