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Colonic segment reversal: A potential surgical option for selected children with short bowel syndrome
Xiaoxia Zhao1, Xiufang Zhi1, Yijiang Han1
1Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Zhejiang Key Laboratory of Neonatal Diseases, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou, 310052, China.
Insights
Colonic segment reversal is a safe and effective surgery for children with short bowel syndrome (SBS). This procedure improved growth and allowed 63.6% of patients to stop parenteral nutrition (PN).
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Short bowel syndrome (SBS) presents significant challenges in pediatric patients.
- Parenteral nutrition (PN) is a common management strategy, but carries risks.
- Surgical interventions aim to improve intestinal function and reduce reliance on PN.
Purpose of the Study:
- To evaluate the clinical value and efficacy of colonic segment reversal in pediatric SBS patients.
- To assess the impact of this procedure on nutritional status, growth, and complications.
Main Methods:
- Retrospective review of 11 children with SBS who underwent colonic segment reversal.
- Evaluation of postoperative intestinal transit time, PN weaning rates, and growth parameters (WAZ).
- Assessment of complications and small intestinal bacterial overgrowth (SIBO) frequency.
Main Results:
- 100% survival rate and a 63.6% PN weaning rate were observed.
- Median time to PN weaning was 3 months; WAZ improved significantly postoperatively.
- Complications were minimal, and SIBO frequency did not significantly increase.
Conclusions:
- Colonic segment reversal is a safe and effective option for selected children with SBS.
- Individualized surgical strategies are crucial, considering residual bowel length and anatomy.
- This procedure offers a viable solution for improving outcomes in complex pediatric SBS cases.
Objective:
To evaluate the clinical value and efficacy of colonic segment reversal in children with short bowel syndrome (SBS).
Methods:
A retrospective review was conducted on 11 children with SBS who underwent colonic segment reversal at our center between January 2016 and October 2025. Postoperative intestinal transit time, weaning rate from parenteral nutrition (PN), and growth parameters (weight-for-age z-score, WAZ), complications, and frequency of small intestinal bacterial overgrowth (SIBO) were evaluated.
Results:
Eleven children (8 males, 3 females) underwent colonic reversal. The overall survival rate was 100% (11/11), and the PN weaning rate was 63.6% (7/11). The median time to PN weaning was 3 months. Postoperative intestinal transit time was prolonged compared with preoperative values (data available for 3 patients). The median preoperative WAZ was -1.85, which improved to -0.87 at 6 months postoperatively. Complications included one case of reversible intestinal obstruction and one case of anastomotic ulcer. The frequency of small intestinal bacterial overgrowth did not increase significantly.
Conclusion:
Colonic segment reversal is a safe and effective surgical option for selected children with SBS, particularly when residual small bowel length is extremely limited. Surgical strategies should be individualized, taking into account residual bowel length, motility, and anatomical conditions.
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