Surgical alternatives for the short bowel syndrome

Since the introduction of total parenteral nutrition an increasing number of patients are surviving massive intestinal resection. However, the expense, morbidity, and inconvenience of this therapy have created interest in surgical alternatives for the treatment of the short bowel syndrome. The goals of surgical therapy in the short bowel syndrome are to slow intestinal transit, increase the area of absorption, and reduce gastric hyperacidity. Antiperistaltic segments or colon interposition benefit patients with sufficient absorptive area, but rapid intestinal transit. Intestinal valves yield inconsistent results. Recirculating loops are associated with prohibitive morbidity and mortality. Experience with intestinal pacing is limited. Patients with dilated bowel segments may benefit from intestinal tapering or lengthening. Growing neomucosa holds promise but has not been evaluated clinically. Despite recent advances in immunosuppression the results of transplantation remain unsatisfactory. Gastric hyperacidity can be effectively controlled by H2 receptor antagonists. None of the operations for treatment of the short bowel syndrome is sufficiently safe and effective to recommend their routine use. Operations should be performed only on selected patients to achieve specific goals. Although investigation continues, our emphasis should continue to be prevention of intestinal resection and conservation of as much of the intestine as possible when massive resection is necessary.