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Longitudinal intestinal lengthening and tailoring: results in 20 children
1Neonatal Surgical Unit, St Mary's Hospital, Manchester, England.
Insights
Longitudinal intestinal lengthening and tailoring (LILT) offers hope for short-bowel syndrome. Early intervention in children with over 40 cm of residual bowel improves survival rates and reduces liver complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Short-bowel syndrome (SBS) presents a significant challenge in pediatric care.
- Longitudinal intestinal lengthening and tailoring (LILT) is an emerging surgical technique for SBS.
Purpose of the Study:
- To evaluate the long-term outcomes of LILT in children with SBS.
- To identify factors influencing survival and complications after LILT.
Main Methods:
- A retrospective analysis of 20 children who underwent LILT between 1962 and 1997.
- Assessment of overall survival, morbidity, residual bowel length, and hepatic function at a mean follow-up of 6.4 years.
Main Results:
- Overall survival was 45% with negligible morbidity and no operative mortality.
- Survivors typically had >40 cm of residual small bowel and minimal hepatic dysfunction.
- Non-survivors had <40 cm of residual bowel and developed severe hepatic dysfunction.
Conclusions:
- LILT is a viable treatment for SBS with acceptable safety.
- Adequate residual small bowel length (>40 cm) is crucial for favorable outcomes.
- Early LILT in well-conditioned children may prevent liver damage and enhance adaptation.
Abstract:
Longitudinal intestinal lengthening and tailoring (LILT) is increasingly favoured as a treatment for short-bowel syndrome. In a personal series, 20 children underwent LILT between 1962 and 1997. There was negligible morbidity (hemiloop anastomotic stenosis in 2) and no operative mortality. At a mean follow-up of 6.4 years overall survival was 45%, and certain features were clearly related to outcome. Survivors had > 40 cm of residual small bowel (commonly jejunum) and had little hepatic dysfunction despite parenteral nutrition of similar time and nature as non-survivors. Children who did not survive had < 40 cm of residual small bowel and developed early lethal hepatic dysfunction of unclear aetiology. Outcome did not seem to be influenced by the presence of the ileocaecal valve or the length of residual colon. Children born with short-bowel should be offered LILT at an early stage when still in good physical condition, so as to avoid liver-damaging intraluminal stasis and bacterial translocation and to enhance intestinal adaptation and hepatoprotective factors.