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Repeat serial transverse enteroplasty procedure (reSTEP): Is it worth it?

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Summary

Repeat serial transverse enteroplasty (reSTEP) shows similar outcomes to single STEP, improving enteral tolerance and reducing infections. Further evaluation is needed for reSTEP in infants with gastroschisis.

Keywords:
Bowel transplantationBowel-derived bloodstream infectionComplicationsEnteral autonomy & toleranceGrowthLevel of evidence: IIISerial transverse enteroplasty procedure

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • The effectiveness of repeat serial transverse enteroplasty (reSTEP) is debated when patients do not achieve enteral autonomy.
  • This study compares reSTEP outcomes to single serial transverse enteroplasty (oneSTEP) and identifies risk factors for reSTEP failure.

Purpose of the Study:

  • To compare the outcomes of reSTEP versus oneSTEP.
  • To identify patient characteristics associated with reSTEP failure.

Main Methods:

  • A retrospective review of all serial transverse enteroplasty (STEP) procedures performed at the institution.
  • Evaluation of growth, enteral autonomy, bloodstream infections, complications, and need for bowel transplantation.

Main Results:

  • reSTEP patients were younger at initial surgery compared to oneSTEP patients.
  • Weight-for-length z-scores improved post-reSTEP, and bowel-derived bloodstream infections decreased after both oneSTEP and reSTEP.
  • Enteral autonomy was achieved in 37.5% of patients; complication rates were low for both procedures, with three patients requiring bowel transplantation.

Conclusions:

  • reSTEP demonstrates comparable postoperative outcomes to oneSTEP, including improved enteral tolerance and reduced infection rates, supporting its use when indicated.
  • Further investigation into reSTEP in young infants with a history of gastroschisis is warranted.