Document Detail


Autologous intestinal reconstructive surgery to reduce bowel dilatation improves intestinal adaptation in children with short bowel syndrome.
MedLine Citation:
PMID:  23343940     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Sarah L Almond; Zeni Haveliwala; Basem Khalil; Antonino Morabito
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  56     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-29     Completed Date:  2014-01-10     Revised Date:  2014-02-11    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  631-4     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Allostasis*
Child, Preschool
Cohort Studies
Dilatation, Pathologic / etiology,  prevention & control*
England / epidemiology
Enteral Nutrition
Female
Follow-Up Studies
Hospitals, Pediatric
Humans
Incidence
Infant
Intestinal Absorption*
Intestinal Mucosa / metabolism
Intestines / pathology,  physiopathology,  surgery*,  transplantation
Male
Organ Size
Parenteral Nutrition, Total
Postoperative Complications / epidemiology,  prevention & control
Prospective Studies
Reconstructive Surgical Procedures* / adverse effects
Short Bowel Syndrome / metabolism,  physiopathology,  surgery*
Transplantation, Autologous
Comments/Corrections
Comment In:
J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):e11-2   [PMID:  24145620 ]
J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):e12   [PMID:  24157449 ]

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