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Published on: December 1, 2012
Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition
David F Mercer1, Brandy D Hobson2, Brandi K Gerhardt1
1Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Insights
Serial transverse enteroplasty (STEP) safely reduces parenteral calorie needs in children with short bowel syndrome within one year. This procedure aids in achieving enteral independence for improved long-term outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Short bowel syndrome (SBS) presents significant nutritional challenges in children.
- Serial transverse enteroplasty (STEP) is a surgical technique to increase functional bowel length.
- Evaluating STEP's impact on nutritional support and complications is crucial for SBS management.
Purpose of the Study:
- To assess the effects of serial transverse enteroplasty (STEP) on parenteral and enteral caloric intake in pediatric short bowel syndrome.
- To analyze short- and long-term complications associated with the STEP procedure.
- To determine the efficacy of STEP in achieving nutritional independence.
Main Methods:
- Retrospective analysis of prospectively collected data from a single-center cohort.
- Inclusion of demographic, clinical, and operative data for patients undergoing STEP.
- Detailed nutritional and growth data collected for 6 months pre- and 12 months post-STEP.
Main Results:
- Fifty-one patients underwent 68 STEP procedures, with a median initial bowel length of 51 cm and 54% length gain.
- Parenteral calorie requirements decreased significantly by 1 year post-STEP (<20 kCal/kg/d).
- Higher length gains correlated with increased stricture risk; 60% of nontransplanted children achieved enteral independence.
Conclusions:
- Serial transverse enteroplasty (STEP) is a safe and well-tolerated procedure for pediatric short bowel syndrome.
- STEP demonstrates a clear benefit in reducing parenteral caloric support within the first year post-operation.
- The procedure plays a vital role in facilitating enteral independence for children with SBS.
Objective:
To analyze the effects of serial transverse enteroplasty (STEP) on parenteral and enteral calories in children with short bowel syndrome, and examine short- and long-term complications.
Study Design:
A retrospective analysis of prospectively-collected data from a large single center cohort of patients undergoing STEP procedure was analyzed. Baseline demographic and clinical information, operative data, and short- and long-term complications were recorded. Detailed growth and nutritional data were obtained for 6 months prior and 12 months following STEP procedure.
Results:
Sixty-eight procedures were performed in 51 patients over a 68-month period. Median bowel length at first STEP was 51 cm with a median length gain of 54%. Repeat STEP patients had longer initial length (77 cm) and reduced length gain (20%). Operative times and blood loss were low, with few complications. Parenteral calorie requirement was stable or rising for 6 months prior to STEP, but decreased to median <20 kCal/kg/d at 1 year postop. Longer length gains were associated with higher risk of stricture formation. Seven children were transplanted, and 60% of nontransplanted children were enterally independent, with the remainder making ongoing progress; 48/51 children are alive at a median of 39 months follow-up.
Conclusions:
STEP is shown to be safe, well tolerated, and to have definitive benefit in reducing parenteral calorie requirements over the first year following the procedure. It has an important role in achieving enteral independence in children with short bowel syndrome.
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