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Dagorno C, Montalva L, Capito C, Lavrand F, Guinot A, De Napoli Cocci S, Gelas T, Dubois R, Dariel A, Dugelay E, Chardot C, Bonnard A. Serial Transverse Enteroplasty (STEP) for Short Bowel Syndrome (SBS) in Children: A Multicenter Study on Long-term Outcomes. J Pediatr Surg 2024:161909. [PMID: 39368852 DOI: 10.1016/j.jpedsurg.2024.161909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/31/2024] [Accepted: 09/04/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVES Short Bowel Syndrome (SBS), secondary to various underlying diseases, is one of the main causes of intestinal failure in children. Surgical management by serial transverse enteroplasty (STEP), is feasible in selected cases, but results on long-term follow-up are scarce. The aim of this study was to report long-term outcomes of the STEP procedure in children with SBS. METHODS We performed a multicenter national retrospective study reviewing medical charts of children who underwent a STEP technique between 2000 and 2022 in 6 university hospitals. Collected data included demographics, SBS history, surgical procedures, nutritional support (enteral or parenteral), STEP management, complications, and outcomes (nutritional support, digestive symptoms, growth). RESULTS STEP was performed in 36 SBS, resulting from 14 gastroschisis, 10 intestinal atresia, 8 necrotizing enterocolitis (NEC), 2 midgut volvulus, and 2 intestinal Hirschsprung disease. Median age at first STEP was 10.8 months [4.5; 63.8]. Bowel length significantly increased (47 vs 70 cm, p < 0.01), with a median gain of 16 cm [11; 25] or 34%. At surgery, 33 children had parenteral nutrition (PN). A second STEP was performed in 11 patients, at a median age of 4.2 years [2.8; 6.8]. One patient underwent a third STEP. Two children required intestinal transplantation. Median follow-up was 7 years [4.4;11.4]. Out of 33 children requiring PN before surgery, 14 children were weaned off PN. The remaining 19 children still required PN, but their dependency decreased by 19%. Out of 17 children presenting severe intestinal dilations and bacterial overgrowth, 12 became asymptomatic. Out of 20 with chronic obstructive symptoms, 8 patients still required supplementary PN whereas 12 achieved complete enteral autonomy, including 3 requiring supplementary enteral support. CONCLUSION STEP technique remains a surgical option in the management of these children, enabling a decrease in PN dependency, resulting in weaning off PN in some cases, as well as an improvement of clinical symptoms. TYPE OF STUDY Retrospective multicenter observational study. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Claire Dagorno
- Department of Pediatric Surgery, Robert-Debré Children's University Hospital, APHP, Paris, France; Department of General Pediatric Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Louise Montalva
- Department of Pediatric Surgery, Robert-Debré Children's University Hospital, APHP, Paris, France; Paris-Cité University, Paris, France; NeuroDiderot, INSERM UMR1141, Paris, France
| | - Carmen Capito
- Department of General Pediatric Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris-Cité University, Paris, France
| | - Frederic Lavrand
- Department of General Pediatric Surgery, Children Hospital, CHU de Bordeaux, France
| | - Audrey Guinot
- Department of General Pediatric Surgery, Children and Mother Hospital, CHU de Nantes, France
| | - Stéphan De Napoli Cocci
- Department of General Pediatric Surgery, Children and Mother Hospital, CHU de Nantes, France
| | - Thomas Gelas
- Department of General Pediatric Surgery, Hospices Civils de Lyon, Children and Mother Hospital, CHU de Lyon, France
| | - Rémi Dubois
- Department of General Pediatric Surgery, Hospices Civils de Lyon, Children and Mother Hospital, CHU de Lyon, France
| | - Anne Dariel
- Department of General Pediatric Surgery, Timone Hospital, CHU de Marseille, France
| | - Emmanuelle Dugelay
- Department of Pediatric Gastro-enterology, Robert-Debré Children's University Hospital, APHP, Paris, France
| | - Christophe Chardot
- Department of General Pediatric Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris-Cité University, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery, Robert-Debré Children's University Hospital, APHP, Paris, France; Paris-Cité University, Paris, France; NeuroDiderot, INSERM UMR1141, Paris, France.
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Kurdi M, Mokhtar A, Elkholy M, El-Wassia H, Bamehriz M, Kurdi A, Khirallah M. Antimesenteric sleeve tapering enteroplasty with end-to-end anastomosis versus primary end-to-side anastomosis for the management of jejunal/ileal atresia. Asian J Surg 2023; 46:3642-3647. [PMID: 36646621 DOI: 10.1016/j.asjsur.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE Small bowel atresia commonly causes neonatal intestinal obstructions. Technical problems are associated with the surgical management of atresia using primary end-to-end anastomosis. Furthermore, the significantly dilated proximal loop may be associated with the stasis of intestinal fluid, thus increasing pressure on the anastomosis and prolonging fasting time before initiation of oral intake. This study aimed to perform antimesenteric tapering of the proximal loop using a linear stapler to reduce its diameter and facilitate anastomosis with the distal loop. METHODS This retrospective study included 57 neonates diagnosed with jejunoileal atresia. They were categorised into two groups: Group A (n = 29), which included neonates treated using antimesenteric sleeve enteroplasty tapering using a linear stapler and Group B (n = 28), which included neonates treated at the primary end of the proximal loop to the side of the distal loop anastomosis. RESULTS The mean operative time was 122.5 min in group A vs. 118 min in group B, and the mean duration to reach full oral intake was 17 days in group A vs. 20.2 days in group B (p = 0.03). The mean length of hospital stay was 25 and 35 days in groups A and B, respectively (p = 0.042). CONCLUSION Tapering the proximal dilated bowel loop to achieve anastomosis with the distal loop improved the transient time, reduced stasis and its associated translocation and colonisation, and allowed for early initiation and maintenance of oral intake. All these parameters shortened the overall length of hospital stay.
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Affiliation(s)
- Mazen Kurdi
- King Abdelaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmed Mokhtar
- King Abdelaziz University Hospital, Jeddah, Saudi Arabia
| | - Mahoud Elkholy
- King Abdelaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Maha Bamehriz
- King Abdelaziz University Hospital, Jeddah, Saudi Arabia
| | - Aya Kurdi
- King Abdelaziz University Hospital, Jeddah, Saudi Arabia
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Norsa L, Goulet O, Alberti D, DeKooning B, Domellöf M, Haiden N, Hill S, Indrio F, Kӧglmeier J, Lapillonne A, Luque V, Moltu SJ, Saenz De Pipaon M, Savino F, Verduci E, Bronsky J. Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2023; 77:298-314. [PMID: 37256821 DOI: 10.1097/mpg.0000000000003850] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.
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Affiliation(s)
- Lorenzo Norsa
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Olivier Goulet
- the Department of Pediatric Gastroenterology-Hepatology-Nutrition, APHP Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Daniele Alberti
- the Department of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
- the Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara DeKooning
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Susan Hill
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Flavia Indrio
- the Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Jutta Kӧglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Alexandre Lapillonne
- the Neonatal Intensive Care Unit, APHP Necker-Enfants Malades Hospital, Paris Cité University, Paris, France
- the CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Veronica Luque
- Serra Hunter, Universitat Rovira I Virgili, IISPV, Tarragona, Spain
| | - Sissel J Moltu
- the Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Miguel Saenz De Pipaon
- the Department of Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Francesco Savino
- the Dipartimento di Patologia e cura del bambino "Regina Margherita", A.U.O. Città delle Salute e della Scienza di Torino, Torino, Italy
| | - Elvira Verduci
- the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi University of Milan, Milan, Italy
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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Wendel D, Javid PJ. Medical and Surgical Aspects of Intestinal Failure in the Child. Surg Clin North Am 2022; 102:861-872. [DOI: 10.1016/j.suc.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bardwell C, El Demellawy D, Oltean I, Murphy M, Agarwal A, Hamid JS, Reddy D, Barrowman N, de Nanassy J, Nasr A. Establishing normal ranges for fetal and neonatal small and large intestinal lengths: results from a prospective postmortem study. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000397. [DOI: 10.1136/wjps-2021-000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo establish reference intervals (RIs) for fetal and neonatal small and large intestinal lengths.MethodsLinear measurements on small and large intestines were made upon postmortem examination of 131 preterm and term infants with gestational ages between 13 and 41 weeks. All cases were referred from the Eastern Ontario and Western Québec regions to a tertiary care hospital. Age and sex partitions were considered and RI limits were estimated.ResultsData consisted of 72 male (54.96%) and 59 female (45.04%) fetuses and neonates with mean gestational age of 25.6 weeks. Results showed that small and large intestinal lengths increased linearly with gestational age. RIs for small intestinal length (cm) of fetuses and neonates aged 13–20 weeks were (21.1, 122.4); of those aged 21–28 weeks were (57.7, 203.8); of those aged 29–36 weeks were (83.6, 337.1); and of those aged 37–41 weeks were (132.8, 406.4). RIs for large intestinal length (cm) of fetuses and neonates from the same four age groups were (5.1, 21.4), (12.7, 39.7), (32.4, 62.4), and (29.1, 82.2).ConclusionsEstablishing accurate RIs for premature and term infants has clinical relevance for pathologists performing postmortem analysis and for surgeons planning postoperative management of patients. The results of this study reaffirm that fetal small and large intestinal lengths increase linearly with gestational age irrespective of sex. Future studies should aim to further investigate the role of possible confounders on growth of fetal intestinal length, including maternal factors such as age and substance use during pregnancy.
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Koivusalo A, Karila K, Pakarinen M. Late Abdominal Reoperations after Surgery for Necrotizing Enterocolitis and Spontaneous Intestinal Perforation. Eur J Pediatr Surg 2021; 31:535-540. [PMID: 33440455 DOI: 10.1055/s-0040-1722616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim of this study was retrospective assessment of late major reoperations after surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in neonates. MATERIALS AND METHODS Appropriate ethical consent was obtained. Data collection was by review of hospital records of 165 successive prematures who underwent surgery for NEC (n = 99) or SIP (n = 66) from 1986 to 2019. Outcome measures were late major abdominal surgeries or endoscopies that occurred after the primary surgical treatment, closure of enterostomies, and weaning from parenteral nutrition (PN). We assessed also risk factors for late abdominal surgeries. RESULTS Hundred and twenty-six (76%) patients (NEC, n = 70, 71% and in SIP, n = 56, 85%) survived. Median follow-up was 13 (interquartile range: 5.9-23) years. Nineteen (15%) patients underwent late abdominal surgery with 0% mortality. Most common was surgery for small bowel obstruction (SBO) in 12(9.5%) patients (NEC, n = 5; 7.0%, SIP, n = 7; 13%, p = 0.36) with 10-year cumulative risk of 8.7 (95% confidence interval [CI]: 3.5-14). Long duration of PN and development of intestinal failure associated cholestasis (IFAC) increased the risk of SBO surgery, relative risk: 1.0-3.2 (95% CI: 1.0-9.1), p = 0.02-0.03. Other surgeries included serial transverse enteroplasty (NEC, n = 2), incisional hernia repair (n = 3), cholecystectomy (n = 1), and ovarian torsion (n = 1). Twenty (29%) NEC and four (7%) SIP patients required endoscopic assessment of postoperative symptoms (p = 0.003). CONCLUSION Late abdominal reoperations occurred in 15% of patients with NEC and SIP with nil mortality. SBO was the main indication. Risk of SBO was similar between NEC and SIP. Long PN and IFAC increased the risk of SBO.
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Affiliation(s)
- Antti Koivusalo
- New Childreńs Hospital, University of Helsinki, Pediatric Surgery, Helsinki, Finland
| | - Kristiina Karila
- New Childreńs Hospital, University of Helsinki, Pediatric Surgery, Helsinki, Finland
| | - Mikko Pakarinen
- New Childreńs Hospital, University of Helsinki, Pediatric Surgery, Helsinki, Finland
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Dewberry LC, Hilton SA, Vuille-dit-Bille RN, Liechty KW. Is Tapering Enteroplasty an Alternative to Resection of Dilated Bowel in Small Intestinal Atresia? J Surg Res 2020; 246:1-5. [DOI: 10.1016/j.jss.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/13/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
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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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Geng L, Zhou L, Ding GJ, Xu XL, Wu YM, Liu JJ, Fu TL. Alternative technique to save ischemic bowel segment in management of neonatal short bowel syndrome: A case report. World J Clin Cases 2019; 7:3353-3357. [PMID: 31667191 PMCID: PMC6819291 DOI: 10.12998/wjcc.v7.i20.3353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital short bowel syndrome (SBS) associated with malrotation, gut volvulus and jejuno-ileal atresia is a very rare condition. It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.
CASE SUMMARY We report a newborn baby with gut malrotation associated with jejuno-ileal atresia, congenital SBS and jejunal volvulus. Hematemesis and abdominal distention were noted. At laparotomy, malrotation associated with jejuno-ileal atresia, congenital SBS and jenunal volvulus was confirmed. The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm, including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment. The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter. Ladd’s procedure, necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed. The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure. Three months later, to restore the continuity of the isolated gut segment, end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed. The entire functional small bowel length increased to 80 cm. Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively. Twelve months later, her body weight was 9.5 kg.
CONCLUSION Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.
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Affiliation(s)
- Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Lei Zhou
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Guo-Jian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xiao-Liang Xu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Yu-Mei Wu
- Department of Neonatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ji-Jun Liu
- Department of Anorectal Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ting-Liang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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Fitzgerald K, Muto M, Belza C, De Silva N, Avitzur Y, Wales PW. The evolution of the serial transverse enteroplasty for pediatric short bowel syndrome at a single institution. J Pediatr Surg 2019; 54:993-998. [PMID: 30803790 DOI: 10.1016/j.jpedsurg.2019.01.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/27/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The serial transverse enteroplasty (STEP) tapers and lengthens the gut to improve adaptation. Mortality has decreased with multidisciplinary intestinal rehabilitation programs (IRP) allowing more time to reach adaptive potential. We reviewed our STEP experience to compare surgical outcomes between early and late eras of our IRP. METHODS A retrospective cohort study of all STEP patients managed by our IRP (Jan 2003-Dec 2016; era 1 2003-2005, era 2 2006-2016) was completed. Patient demographics, operative data, complications, and outcome data were collected. Univariate analysis between eras with nonparametric statistics was performed. RESULTS Thirty-six patients received STEP (Era 1 = 12; Era 2 = 24) [median age 5mo; males 22/36 (61.1%)]. In Era 2 a higher proportion had gastroschisis (8.3% vs 58.3%); p = 0.004) and shorter pre-STEP small bowel remnant (48 vs 111 cm, p = 0.001). The median increase in bowel length post-STEP was 52.9%. Overall, 42% of patients reached enteral autonomy (Era 1 7/12 (58%) vs Era 2 8/24 (33%); p = 0.15). Median time to PN discontinuation was shorter in Era 1 (259 vs 968 days, p = .208). Staple line complications were higher in Era 1 (16.7% vs 0%; p = 0.040). CONCLUSION Presently, STEP is reserved for a specific subset of IRP patients, allowing 42% to wean off PN. STEP's use should be under the umbrella of a multidisciplinary IRP. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kevin Fitzgerald
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA
| | - Mitsuru Muto
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA
| | - Christina Belza
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA
| | - Nicole De Silva
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA
| | - Yaron Avitzur
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA
| | - Paul W Wales
- The Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA; Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA.
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Lauro A, Lacaille F. Short bowel syndrome in children and adults: from rehabilitation to transplantation. Expert Rev Gastroenterol Hepatol 2019; 13:55-70. [PMID: 30791840 DOI: 10.1080/17474124.2019.1541736] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Short bowel syndrome (SBS) is a dramatic clinical condition in both children and adults; the residual bowel length is not sufficient to avoid intestinal failure, with subsequent malnutrition and growth retardation, and intravenous support is required to provide the nutrients normally coming from the intestine. Apart from the primary disease, the medical status can be worsened by complications of intestinal failure: if there are irreversible, the prognosis is poor unless a successful intestinal rehabilitation is achieved. Areas covered: The rescue of the remnant small bowel requires a multidisciplinary expertise to achieve digestive autonomy. The use of intestinal trophic factors has shown encouraging results in improving the intestinal adaptation process. Whenever the residual bowel length is inadequate, in a well-selected population weaning parenteral nutrition (PN) off could be attempted by surgery through lengthening procedures. A further subset of patients, with total and irreversible intestinal failure and severe complications on PN, may have an indication to intestinal transplantation. This procedure is still affected by poor long-term results. Expert commentary: Novel approaches developed through a multidisciplinary team work, such as manipulation of microbiota or tissue bioengineering, should be added to current therapies to treat successfully SBS.
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Affiliation(s)
- Augusto Lauro
- a Emergency Surgery Department , St. Orsola University Hospital , Bologna , Italy
| | - Florence Lacaille
- b Gastroenterology Hepatology Nutrition Unit , Hôpital Necker-Enfants Malades , Paris , France
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Abstract
The management of short bowel syndrome has mainly been focused on intestinal rehabilitation as part of multidisciplinary team approach in specialized centers. While some patients go through a process of bowel adaptation that allows them to reach enteral autonomy, others reach a plateau before this and require prolonged parenteral nutrition and/or intestinal transplantation. Various autologous intestinal reconstruction procedures centered on bowel tapering have been described to increase functional intestinal area and help gain enteral autonomy. This review discusses the surgical techniques, advantages, limitations, and general outcomes of each procedure.
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Affiliation(s)
- Gabriel Ramos-Gonzalez
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3 Boston, MA 02115, United States
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3 Boston, MA 02115, United States.
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13
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Merras-Salmio L, Mutanen A, Ylinen E, Rintala R, Koivusalo A, Pakarinen MP. Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984-2017. JPEN J Parenter Enteral Nutr 2018; 42:1304-1313. [DOI: 10.1002/jpen.1164] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Laura Merras-Salmio
- Department of Pediatric Gastroenterology; Helsinki University Children's Hospital; Helsinki Finland
- Pediatric Liver and Gut Research Group; University of Helsinki; Helsinki Finland
| | - Annika Mutanen
- Pediatric Liver and Gut Research Group; University of Helsinki; Helsinki Finland
- Department of Pediatric Surgery; Helsinki University Children's Hospital; Helsinki Finland
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantations, Helsinki University Children's Hospital; University of Helsinki; Helsinki Finland
| | - Risto Rintala
- Department of Pediatric Surgery; Helsinki University Children's Hospital; Helsinki Finland
| | - Antti Koivusalo
- Department of Pediatric Surgery; Helsinki University Children's Hospital; Helsinki Finland
| | - Mikko P. Pakarinen
- Pediatric Liver and Gut Research Group; University of Helsinki; Helsinki Finland
- Department of Pediatric Surgery; Helsinki University Children's Hospital; Helsinki Finland
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Hukkinen M, Mutanen A, Pakarinen MP. Small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel-derived bloodstream infections, and hepatic injury. Surgery 2017; 162:670-679. [DOI: 10.1016/j.surg.2017.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 01/04/2023]
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