Surgical considerations in the short bowel syndrome

None of the current surgical alternatives for the short bowel syndrome is sufficiently safe and effective to be used routinely. Surgical therapy should be considered only in selected patients to achieve specific results. Patients with dilated intestinal segments and stasis may benefit from intestinal tapering and lengthening. The results of intestinal transplantation in animals have improved and justify clinical attempts, but recent experience in humans has been disappointing. Growing neomucosa has not been shown to increase absorption, but the patching technique may be useful in preserving intestinal length. Patients with sufficient absorptive area but rapid transit may benefit from colon interposition or intestinal valves. Thus, the surgical emphasis should continue to be prevention of intestinal resection and conservation of intestinal length when resection is required.