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Sequential intestinal lengthening procedures for refractory short bowel syndrome
K Georgeson1, D Halpin, R Figueroa
1Department of Pediatric Surgery, Children's Hospital, Birmingham, AL 35233.
Insights
Surgical lengthening of the small intestine improved outcomes for children with refractory short bowel syndrome, enabling increased enteral feeding and reduced reliance on parenteral nutrition (PN).
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intestinal Rehabilitation
Background:
- Neonatal short bowel syndrome (SBS) survival has improved due to better parenteral nutrition (PN) management.
- Most infants with SBS achieve enteral adaptation and wean from PN.
- Refractory SBS cases require advanced interventions beyond standard care.
Purpose of the Study:
- To describe clinical experience with gut lengthening procedures in pediatric patients with refractory SBS.
- To evaluate the efficacy of surgical interventions in improving enteral autonomy.
- To assess long-term outcomes of small bowel lengthening in children.
Main Methods:
- Retrospective review of nine pediatric patients with refractory SBS undergoing small bowel lengthening.
- Procedures included small bowel nipple valve creation, Bianchi technique, and Kimura technique.
- Analysis of preoperative enteral tolerance, postoperative outcomes, and PN dependence.
Main Results:
- Sixteen lengthening procedures were performed across nine patients.
- Preoperatively, patients tolerated <10% enteral caloric intake; small bowel length increased ~2.5x.
- Two patients weaned completely from PN; average enteral intake reached 50% for long-term survivors.
Conclusions:
- Small bowel lengthening procedures can significantly improve enteral tolerance in refractory SBS.
- Surgical intervention offers a viable option for patients failing to adapt enterally.
- Further research is warranted to optimize surgical techniques and long-term management.
Abstract:
Better understanding of the long-term delivery of parenteral nutrition (PN) in neonates and children has increased the survival for patients who have neonatal short bowel syndrome. Most infants with short bowel syndrome experience progressive enteral adaptation and are weaned from PN. This report describes the authors' clinical experience with nine infants and children who had refractory short bowel syndrome; single or sequential procedures were performed to lengthen the small bowel. Gut lengthening procedures used included a small bowel nipple valve constructed distally, to provide temporary partial obstruction and thereby induce dilatation and lengthening of the proximal small intestine (six patients). Bianchi's technique was used in three patients primarily and in six others after the bowel had been dilated and lengthened by the nipple valve. Kimura's gut lengthening technique was used in one patient after the small bowel had spontaneously become dilated subsequent to a Bianchi procedure. In all, 16 lengthening procedures were performed on the nine patients. Preoperatively, the nine patients tolerated less than 10% of their caloric intake enterally, with no evidence of improvement for a minimum of 6 months. Small bowel segments ranged from 6 to 92 cm originally and were increased an average of 2 1/2 times the original length. Two patients have been totally weaned from PN. For the patients whose lengthening procedure was performed more than 1 year ago, the percentage of enteral caloric intake averages 50%. One of the patients was profoundly impaired neurologically and was not resuscitated from an apneic episode. Another patient died in his sleep of unknown causes 1 year after intestinal lengthening.(ABSTRACT TRUNCATED AT 250 WORDS)