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Outcomes in patients with short bowel syndrome after autologous intestinal reconstruction: Does etiology matter?
Federica Pederiva1, Alberto Sgrò2, Riccardo Coletta3
1Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
Insights
The etiology of short bowel syndrome (SBS) in children does not significantly impact survival after reconstructive surgery. However, volvulus cases showed poorer outcomes in weaning from parenteral nutrition (PN).
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intestinal Failure
Background:
- Short bowel syndrome (SBS) is a leading cause of intestinal failure in pediatric patients.
- Factors influencing survival and parenteral nutrition (PN) weaning in SBS are extensively studied.
- Autologous gastrointestinal reconstructive surgery is a key treatment modality for pediatric SBS.
Purpose of the Study:
- To determine if the underlying cause of SBS affects outcomes in children undergoing autologous gastrointestinal reconstructive surgery.
- To compare survival rates, PN weaning success, and time to enteral autonomy based on SBS etiology.
- To evaluate the impact of specific etiologies on surgical outcomes in pediatric SBS.
Main Methods:
- Retrospective review of pediatric patients with SBS who underwent autologous gastrointestinal reconstructive surgery (2002-2012).
- Patients were categorized into four etiological groups: gastroschisis, volvulus, necrotizing enterocolitis (NEC), and intestinal atresia.
- Outcome measures included survival, age at surgery, pre-operative bowel length, ileocecal valve preservation, and time to enteral autonomy.
Main Results:
- No significant differences in survival or age at surgery were observed among etiological groups.
- The volvulus group exhibited shorter pre-operative bowel length and the lowest rate of successful PN weaning (30%).
- Intestinal atresia had the highest ileocecal valve preservation rate (66%), while gastroschisis had the lowest (10%). Time to enteral autonomy varied significantly by etiology.
Conclusions:
- SBS etiology does not appear to be a significant determinant of overall outcome or survival following reconstructive surgery.
- Patients with volvulus demonstrated a less favorable outcome regarding weaning from PN compared to those with intestinal atresia.
- While overall outcomes are similar, specific etiological factors may influence aspects like PN weaning and time to enteral autonomy.
Background:
Short bowel syndrome (SBS) is the most common cause of intestinal failure in children. Many factors have been investigated in an attempt to define which parameters influence most survival and ability to wean off parenteral nutrition (PN). The aim of this study was to investigate if aetiology of SBS affects the outcomes in paediatric patients treated with autologous gastrointestinal reconstructive surgery.
Methods:
All children with SBS who underwent autologous gastrointestinal reconstructive surgery between 2002 and 2012 were retrospectively reviewed and outcome measures were recorded.
Results:
Forty-three patients were divided into 4 groups according to aetiology (gastroschisis, volvulus, necrotizing enterocolitis (NEC), intestinal atresia). No significant differences were found among groups regarding survival and median age at surgery. The volvulus group had a lower pre-operative bowel length in comparison with gastroschisis and intestinal atresia and the lowest percentage of patients off PN (30%). Gastroschisis had the lowest rate of preserved ileocaecal valve (10%), while intestinal atresia had the highest (66%). For children who weaned off PN, intestinal atresia had also the longest time to achieve enteral autonomy (14.5months), while NEC had the shortest (3.5months), followed by gastroschisis (8.5months). None of the patients needed transplant.
Conclusions:
In our experience it does not appear that diagnosis is significantly related to outcome and this is consistent with the conclusions of other reviews. However, it should be noted that in our series patients with volvulus had the worse outcome in terms of weaning off PN when compared with intestinal atresia.
Type Of Study:
Retrospective Study.
Level Of Evidence:
II.
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