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Early Bowel Lengthening Procedures: Bi-Institutional Experience and Review of the Literature. CHILDREN 2022; 9:children9020221. [PMID: 35204941 PMCID: PMC8870478 DOI: 10.3390/children9020221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
Early bowel lengthening procedure (EBLP) has been defined as any bowel lengthening procedure performed before six months of age. The purpose of this paper is to compare our experience with literature on this subject to identify common indications. A bi-institutional retrospective analysis was performed. Diagnosis, type of surgery, age at procedure and outcomes were analysed. Eleven EBLP were performed in Manchester and Florence from 2006 to 2021. The median age at surgery was 126 days (102–180), pre-operative median short bowel (SB) length was 28 cm (17–49) with a post-operative median increase of 81%. Furthermore, a PubMed/Embase search was undertaken regarding bowel lengthening procedures performed in the last 40 years. Sixty-one EBLP were identified. The median age was 60 days (1–90). Serial transverse enteroplasty (STEP) was the most frequent procedure used, with a median increased bowel length of 57%. This study confirms that no clear consensus on indication or timing to perform early SB lengthening is reported. According to the gathered data, EBLP should be considered only in cases of actual necessity and performed in a qualified intestinal failure centre.
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Morabito A, Ugolini S, Cianci MC, Coletta R. Current Surgical Concepts and Indications in the Management of the Short Bowel State: A Call for the Use of Multidisciplinary Intestinal Rehabilitation Programs. CHILDREN-BASEL 2021; 8:children8080654. [PMID: 34438545 PMCID: PMC8394303 DOI: 10.3390/children8080654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
The mainstay of management for short bowel syndrome (SBS) is to promote access to the best quality of care provided by the intestinal rehabilitation program (IRP) in specialized centres. When treating SBS patients, the main goal is to minimize disease-associated complications, as well as achieve enteral autonomy. Surgical strategies should be selected cautiously upon the actual state of the bowel with respect to what it is clinically relevant for that specific patient. To this aim, a personalized and multidisciplinary approach for such a complex syndrome is needed.
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Affiliation(s)
- Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, 50139 Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (S.U.); (M.C.C.); (R.C.)
- School of Heath and Society, University of Salford, Manchester M6 6PU, UK
- Correspondence:
| | - Sara Ugolini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (S.U.); (M.C.C.); (R.C.)
| | - Maria Chiara Cianci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (S.U.); (M.C.C.); (R.C.)
| | - Riccardo Coletta
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (S.U.); (M.C.C.); (R.C.)
- School of Heath and Society, University of Salford, Manchester M6 6PU, UK
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Restricted v. unrestricted oral intake in high output end-jejunostomy patients referred to reconstructive surgery. Br J Nutr 2021; 125:1125-1131. [PMID: 32873362 DOI: 10.1017/s0007114520003360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The major complication of end jejunostomy is excessive fluid and electrolyte loss through the stoma, leading to hypovolaemia and dyselectrolytaemia within days and malnutrition within weeks. The aim was to compare the results of two nutritional approaches: unrestricted and restricted oral intake in patients with end jejunostomy commencing home parenteral nutrition (HPN) in terms of liver and renal biochemical markers and time to reconstructive bowel surgery with correlation to stoma output. Twenty patients with stabilised high output end-jejunostomy were divided into two groups. Group A consisted of ten patients with oral intake restricted to keep stomal output under 1000 ml. Group B consisted of ten patients with unrestricted oral intake. The following parameters were evaluated over 6 months: stomal output, self-estimation of general condition, body weight gain, plasma bilirubin and creatinine, number of hospitalisations prior to reconstructive surgery, the frequency of ostomy bag emptying, feelings of hunger and thirst in the daytime, and the time to reconstructive surgery. Stoma losses were compensated by parenteral supply. In group B, lower quality of life was observed, reflected by weakness, permanent feelings of hunger and thirst and the need for night-time emptying of the stoma bag. Patients in group B developed more complications and required more time to prepare for surgery. One death occurred in group B due to renal insufficiency followed by septic complications. Restricted oral intake seems to be more effective for prevention of HPN-related complications and shortening of time to surgery. Unrestricted oral intake appears to provoke uncontrolled losses of energy and protein, inhibiting weight gain.
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Abstract
Abstract
Introduction Short bowel syndrome (SBS) refers to the malabsorptive state that occurs following extensive intestinal resection and is associated with several complications.
Methods The research for this review was conducted in the Pubmed database. Relevant scientific articles dated between 1991 and 2015 and written in Portuguese, Spanish or English were selected.
Results Several therapies, including nutritional support, pharmacological options and surgical procedures have been used in these patients.
Conclusions Over the last decades new surgical and pharmacological approaches emerged, increasing survival and quality of life (QoL) in patients with SBS. All SBS patients ought to have an individualized and multidisciplinary care that promotes intestinal rehabilitation.
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Affiliation(s)
- Rosário Eça
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Elisabete Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar de São João, Serviço de Cirurgia Geral, Porto, Portugal
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Letter to the Editor. J Pediatr Surg 2020; 55:1984. [PMID: 25783290 DOI: 10.1016/j.jpedsurg.2013.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
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Bittolo Bon S, Rapi M, Coletta R, Morabito A, Valentini L. Plasticised Regenerated Silk/Gold Nanorods Hybrids as Sealant and Bio-Piezoelectric Materials. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E179. [PMID: 31968575 PMCID: PMC7022986 DOI: 10.3390/nano10010179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/30/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Manual and mechanical suturing are currently the gold standard for bowel anastomosis. If tissue approximation fails, anastomotic leaks occur. Anastomotic leaks may have catastrophic consequences. The development of a fully absorbable, biocompatible sealant material based on a bio-ink silk fibroin can reduce the chance of anastomotic leaks. We have produced a Ca-modified plasticised regenerated silk (RS) with gold nanorods sealant. This sealant was applied to anastomosed porcine intestine. Water absorption from wet tissue substrate applied compressive strains on hybrid RS films. This compression results in a sealant effect on anastomosis. The increased toughness of the hybrid plasticised RS resulted in the designing of a bio-film with superior elongation at break (i.e., ≈200%) and bursting pressure. We have also reported structure-dependent piezoelectricity of the RS film that shows a piezoelectric effect out of the plane. We hope that in the future, bowel anastomosis can be simplified by providing a multifunctional bio-film that makes feasible the mechanical tissue joint without the need for specific tools and could be used in piezoelectric sealant heads.
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Affiliation(s)
- Silvia Bittolo Bon
- Dipartimento di Ingegneria Civile e Ambientale, Università degli Studi di Perugia, UdR INSTM, Strada di Pentima 4, 05100 Terni, Italy;
| | - Michele Rapi
- Università degli Studi di Firenze Laurea Magistrale in Medicina e Chirurgia, Piazza San Marco 4, 50121 Firenze, Italy;
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Firenze, Italy; (R.C.); (A.M.)
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Firenze, Italy; (R.C.); (A.M.)
- Dipartimento Neuroscienze, Psicologia, Area del Farmaco e della Salute del Bambino NEUROFARBA, Università degli Studi di Firenze, Viale Pieraccini 6, 50121 Firenze, Italy
| | - Luca Valentini
- Dipartimento di Ingegneria Civile e Ambientale, Università degli Studi di Perugia, UdR INSTM, Strada di Pentima 4, 05100 Terni, Italy;
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Abstract
Insufficient absorptive mucosal surface is the fundamental problem in the short bowel state. Intestinal adaptation has been well studied, and it is well recognized that it may lead to dilatation of the bowel with increased thickness of the bowel wall, resulting from both mucosal hypertrophy and hyperplasia. Autologous reconstructive surgery exploits bowel dilatation in short bowel syndrome and maximizes the absorptive potential of the available mucosal surface. Indeed, autologous gastrointestinal reconstructive procedures may be better viewed as optimizing bowel diameter rather than focusing on length, thus allowing better prograde peristalsis and improved contact between luminal nutrients and mucosa, ultimately enhancing absorption.
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Affiliation(s)
- Riccardo Coletta
- Department of Paediatric Surgery, Center for Intestinal Reconstruction and Rehabilitation, Meyer Children's Hospital, Viale Gaetanao Pieraccini. 24, Florence 50139, Italy; School of Environment and Life Science, University of Salford, Salford, UK
| | - Antonino Morabito
- Department of Paediatric Surgery, Center for Intestinal Reconstruction and Rehabilitation, Meyer Children's Hospital, Viale Gaetanao Pieraccini. 24, Florence 50139, Italy; School of Environment and Life Science, University of Salford, Salford, UK; Department of NeuroFarBa, University of Florence, Florence, Italy
| | - Kishore Iyer
- Intestinal Rehabilitation & Transplant Program, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave Levy Place, Box 1104, New York, NY 10029, USA.
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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects. Clin Nutr 2018; 37:2392-2400. [DOI: 10.1016/j.clnu.2018.06.953] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
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Pederiva F, Sgrò A, Coletta R, Khalil B, Morabito A. Outcomes in patients with short bowel syndrome after autologous intestinal reconstruction: Does etiology matter? J Pediatr Surg 2018; 53:1345-1350. [PMID: 29628209 DOI: 10.1016/j.jpedsurg.2018.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Short bowel syndrome (SBS) is the most common cause of intestinal failure in children. Many factors have been investigated in an attempt to define which parameters influence most survival and ability to wean off parenteral nutrition (PN). The aim of this study was to investigate if aetiology of SBS affects the outcomes in paediatric patients treated with autologous gastrointestinal reconstructive surgery. METHODS All children with SBS who underwent autologous gastrointestinal reconstructive surgery between 2002 and 2012 were retrospectively reviewed and outcome measures were recorded. RESULTS Forty-three patients were divided into 4 groups according to aetiology (gastroschisis, volvulus, necrotizing enterocolitis (NEC), intestinal atresia). No significant differences were found among groups regarding survival and median age at surgery. The volvulus group had a lower pre-operative bowel length in comparison with gastroschisis and intestinal atresia and the lowest percentage of patients off PN (30%). Gastroschisis had the lowest rate of preserved ileocaecal valve (10%), while intestinal atresia had the highest (66%). For children who weaned off PN, intestinal atresia had also the longest time to achieve enteral autonomy (14.5months), while NEC had the shortest (3.5months), followed by gastroschisis (8.5months). None of the patients needed transplant. CONCLUSIONS In our experience it does not appear that diagnosis is significantly related to outcome and this is consistent with the conclusions of other reviews. However, it should be noted that in our series patients with volvulus had the worse outcome in terms of weaning off PN when compared with intestinal atresia. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Federica Pederiva
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
| | | | - Riccardo Coletta
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK; University of Salford, Lancashire, UK
| | - Basem Khalil
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK; University of Manchester, Faculty of Medical and Human sciences, Manchester Medical School, Manchester, UK; University of Salford, Lancashire, UK
| | - Antonino Morabito
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK; University of Manchester, Faculty of Medical and Human sciences, Manchester Medical School, Manchester, UK; University of Salford, Lancashire, UK.
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10
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Abstract
Extensive loss of small bowel in all age groups has significant morbidity and mortality consequences. Despite the astonishing ability of the small bowel to compensate for an extensive loss, long-term parenteral nutrition and enteral nutrition, tailored to the need of the patients in relation to the missing intestinal regions is needed. Organ-preserving surgical intervention becomes necessary in patients with a very short intestinal transit time and in an other group of patients with impaired propulsive peristalsis. Intestinal transplantation is indicated in recurrent septical infections or if nearly all of the small bowel is missing. This review discusses indications and risks of the organ-preserving surgical therapies in children with short bowel syndrome.
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Affiliation(s)
- Michael E Höllwarth
- University Clinic for Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 36, 8034, Graz, Austria.
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Hommel MJ, van Baren R, Haveman JW. Surgical management and autologous intestinal reconstruction in short bowel syndrome. Best Pract Res Clin Gastroenterol 2016; 30:263-80. [PMID: 27086890 DOI: 10.1016/j.bpg.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/05/2016] [Indexed: 01/31/2023]
Abstract
Short bowel syndrome (SBS) is a serious condition with considerable morbidity and mortality. When treatment with parenteral nutrition fails and life-threatening complications occur, autologous intestinal reconstruction (AIR) should be considered before intestinal transplantation (ITx). Single or combined ITx should be reserved for patients with severe liver disease and as last resort in the treatment of SBS. Longitudinal intestinal lengthening and tailoring (LILT) has proven its value in AIR, but its availability depends on the expertise of the surgeons. Serial transverse enteroplasty (STEP) has similar success rates as LILT and fewer patients progress to ITx. STEP is also applicable at small bowel dilatation in ultra-short bowel syndrome. The scope may be widened when duodenal dilatation can be treated as well. Spiral intestinal lengthening and tailoring (SILT) is a promising alternative. More research is needed to confirm these findings. Therefore we suggest an international data registry for all intestinal lengthening procedures.
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Affiliation(s)
- Matthijs J Hommel
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Robertine van Baren
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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Magnitude of surgical burden associated with pediatric intestinal failure: a multicenter cohort analysis. J Pediatr Surg 2014; 49:1795-8. [PMID: 25487486 PMCID: PMC4620568 DOI: 10.1016/j.jpedsurg.2014.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/05/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown. METHODS Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for >60days. RESULTS A total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (P<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3 (1, 6) versus 1 (0, 3), respectively, P<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing >2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment. CONCLUSIONS Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
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Chan CF, Wu TC. Recent advances in the management of pediatric intestinal failure. Pediatr Neonatol 2014; 55:426-30. [PMID: 24594083 DOI: 10.1016/j.pedneo.2013.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/13/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022] Open
Abstract
Intestinal failure is a chronic condition in which the intestinal tract has lost most of its function. Prognosis depends on the severity and underlying etiologies. Although many patients survive under parenteral nutrition support, they often suffer from fatal complications such as progressive cholestasis and frequent sepsis. In addition, to decide the proper time to refer selected patients to bowel transplantation remains difficult. A noninvasive biomarker developed to evaluate functional enterocyte mass and the extent of intestinal adaptation is plasma citrulline level. It is shown that serum citrulline correlates with small bowel length, oral tolerance, and parenteral nutrition dependency. Recent evidence has revealed that the use of fish oil containing lipid emulsions to substitute traditional soybean-based formula may reverse a patient's cholestasis and improve lipid profiles. A new method used to prevent catheter-related bloodstream infection is ethanol lock therapy. With both antimicrobial and fibrinolytic activities, studies have shown that ethanol locks can effectively decrease catheter infection and replacement rate with no known resistance reported. As part of intestinal rehabilitation, auxiliary surgeries such as longitudinal intestinal lengthening and tailoring, serial transverse enteroplasty, and tapering enteroplasty can be beneficial for selected patients before bridging to bowel transplantation. With the introduction of these new medical and surgical modalities, patients with intestinal failure are having better outcomes than in the past.
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Affiliation(s)
- Chan-Fai Chan
- Department of Pediatrics, National Yang-Ming University Hospital, Yilan, Taiwan; Division of Gastroenterology, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzee-Chung Wu
- Division of Gastroenterology, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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"Spiral intestinal lenghtening and tailoring (SILT)" for a child with severely short bowel. Pediatr Surg Int 2014; 30:1169-72. [PMID: 25119303 DOI: 10.1007/s00383-014-3583-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 12/28/2022]
Abstract
We report a child with post-surgical short bowel state who underwent bowel expansion followed by spiral intestinal lengthening and tailoring (SILT) at 10 months of age. Growth at 1-year follow-up is along the 15-25th centile on 82 % oral calories as normal diet and 18 % as parenteral nutrition, and he is passing 2-3 semisolid motions daily. SILT is a versatile technique for reconstructing dilated bowel towards improved propulsion and absorption, and has a role in the management of the short bowel state.
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Abstract
Although most patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) may benefit from "standard" management, which is deferred emergency surgery, some may present unexpected elements that change this paradigm. Birth weight, associated anomalies, and long gap can influence the therapeutic schedule of the patients with EA/TEF and can make their treatment tricky. As a consequence, detailed information on these aspects gives the power to develop a decision-making process as correct as possible. In this article, we will review the most important factors influencing the treatment of patients with EA/TEF and will share our experience on the diagnostic and therapeutic tips that may provide pivotal help in the management of such patients.
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Affiliation(s)
- Andrea Conforti
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital - Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital - Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital - Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy.
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Affiliation(s)
- Jorge H Vargas
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Geffen-UCLA School of Medicine, Los Angeles, California.
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Autologous intestinal reconstructive surgery to reduce bowel dilatation improves intestinal adaptation in children with short bowel syndrome. J Pediatr Gastroenterol Nutr 2013; 56:631-4. [PMID: 23343940 DOI: 10.1097/mpg.0b013e318287de8d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Intestinal failure (IF) is a common consequence of neonatal small bowel pathology. In our experience, bowel dilatation is often responsible for the IF state in patients who fail to adapt despite adequate residual bowel length. The aim of the present study was to investigate the role of surgery to reduce bowel dilatation, and thus favour PN independence, for these children. METHODS Data were collected prospectively for all of the patients referred to our unit for a 7-year period (2004-2011). Eight patients (2 congenital atresia, 2 gastroschisis with atresia, 1 simple gastroschisis, 3 necrotising enterocolitis) with gut dilatation who failed adaptation despite a bowel length >40 cm were identified. Preoperatively, all patients were totally dependent on parenteral nutrition (PN). Patients were managed by longitudinal intestinal lengthening and tailoring (n = 3), serial transverse enteroplasty (n = 2), or tapering enteroplasty (n = 3). RESULTS Median age at time of surgery was 273 days (103-1059). Mean gut length increased from 51 (35-75) to 73 cm (45-120) following surgery (P = 0.02). Incidence of sepsis (P = 0.01) and peak serum bilirubin levels (P = 0.005) were reduced postoperatively. PN was discontinued after a median of 110 days (35-537) for 7 patients; 1 patient remains on PN 497 days after surgery. CONCLUSIONS These data indicate that reconstructive surgery to reduce bowel diameter may be an effective technique for treating IF in patients with short bowel syndrome, without sacrificing intestinal length. We suggest that this technique may reduce the need for bowel transplantation in this group of patients.
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