Surgical therapy of the short bowel syndrome

Patients with the short bowel syndrome should be managed initially by giving total parenteral nutrition and by maximizing the function of the remaining intestine. Enteral feedings should be instituted as soon as the patient stabilizes, usually after 2 to 4 weeks. The gastric hypersecretion that accompanies the syndrome can usually be controlled with an H2-receptor blocker. In those patients who fail to recover adequate digestion and absorption after 6 months to 1 year, operations to improve absorption should be considered. The reversed intestinal segment and the intestinal lengthening procedures are most often employed, but neither type of operation can be recommended without reservation. Newer procedures, such as growing new intestinal mucosa on serosal patches, intestinal pacing, and intestinal transplantation may play a role in future therapies. At present, long-term parenteral nutrition remains the cornerstone of therapy.