Document Detail


Experience with longitudinal intestinal lengthening and tailoring.
MedLine Citation:
PMID:  10532271     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Over a 16-year period, 20 neonates and infants with short-bowel syndrome underwent longitudinal intestinal lengthening and tailoring because of a dysfunctional dilated jejunum. There was no operative mortality, and morbidity was limited to 2 hemiloop anastomotic stenoses and 1 spontaneously resolving air and bile leak. Long-term survival was 45%. Survivors had >40 cm residual jejunum and a greater number also retained their ileocaecal valve and a longer colonic length. They underwent bowel lengthening at a later time and had minimal hepatic dysfunction. 7 of 9 survivors established full enteral nutrition. These children could be regarded as self-selected survivors with residual bowel dysfunction who had come through the hazardous neonatal phase with minimal hepatic injury. Non-survivors often had <40 cm jejunum and limited distal colon. Death was commonly due to end-stage liver failure. It is likely that the severely reduced gut-associated lymphoid tissue contributed to increased bacterial translocation from the dilated bowel and early onset of progressive liver injury. It is possible to conclude that bowel lengthening should be offered only to self-selected survivors with residual bowel dysfunction and minimal liver injury. It seems, however, even more appropriate, to offer early bowel tailoring and lengthening with its recognized reduction in stasis and bacterial translocation, improved absorption and enhanced intestinal adaption, particularly to those high-risk neonates with <40 cm of dilated jejunum with a view to reducing the risk of infection and lethal hepatic injury, thereby improving their chances for quality survival.
Authors:
A Bianchi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie     Volume:  9     ISSN:  0939-7248     ISO Abbreviation:  Eur J Pediatr Surg     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-11-16     Completed Date:  1999-11-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9105263     Medline TA:  Eur J Pediatr Surg     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  256-9     Citation Subset:  IM    
Affiliation:
The Neonatal Surgical Unit, St. Mary's Hospital Manchester, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anastomosis, Surgical / methods*
Child
Follow-Up Studies
Gastroschisis / surgery*
Humans
Infant
Infant, Newborn
Intestine, Small / abnormalities*,  surgery*
Liver Failure / etiology
Parenteral Nutrition
Short Bowel Syndrome* / complications,  mortality,  therapy
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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