Autologous Intestinal Reconstructive Surgery to Reduce Bowel Dilatation Improves Intestinal Adaptation in Children With Short Bowel Syndrome

Almond, Sarah L.*; Haveliwala, Zeni; Khalil, Basem*; Morabito, Antonino*

Journal of Pediatric Gastroenterology & Nutrition: June 2013 - Volume 56 - Issue 6 - p 631–634
doi: 10.1097/MPG.0b013e318287de8d
Original Articles: Gastroenterology

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.

*Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester

Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.

Address correspondence and reprint requests to Sarah Almond, Specialist Registrar in Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK (e-mail: sarah.l.almond@gmail.com).

Received 29 April, 2012

Accepted 14 January, 2013

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN