nach oben

Erschienen in:

13.03.2019 | Original Article

Autologous intestinal reconstruction: a single institution study of the serial transverse enteroplasty (STEP) and the longitudinal intestinal lengthening and tailoring (LILT)

verfasst von: Adil A. Shah, Mikael Petrosyan, Ashanti L. Franklin, Alfred A. Chahine, Clarivet Torres, Anthony D. Sandler

Erschienen in: Pediatric Surgery International | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To review the effectiveness of the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) operations in a cohort of patients with short bowel syndrome (SBS).

Methods

We conducted a retrospective analysis of children with SBS treated at our institution from 2004 until 2014. Children aged 0 days to 18 years with SBS who underwent autologous intestinal reconstruction were included in the study.

Results

Twenty-two SBS patients underwent 31 different lengthening procedures (LP). Seventeen patients underwent their primary lengthening procedures at our institution: 9 (53%) patients underwent a LILT, 7 (41%) underwent a STEP and 1 (6%) had a simultaneous LILT and STEP procedure. 12/22 patients had a second STEP, two had a third STEP and one patient had an intestinal transplantation after the LP. Median intestinal length at the time of surgery was 25 cm (range 12–90 cm). There was no difference in gain of intestinal length after LILT vs. STEP (p = 0.74). Length of stay and initiation of feeds were similar. Serum albumin increased after autologous bowel lengthening (p < 0.001). 50% were weaned off parenteral nutrition (PN) (5/9 of the LILT, 1/7 of the STEP, 1/1 of the combined LILT/STEP). There were no surgical complications or deaths.

Conclusion

In patients with SBS, LILT and STEP procedures are effective for autologous intestinal reconstruction and enable intestinal rehabilitation.

O’Keefe SJ et al (2006) Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol 4(1):6–10CrossRefPubMed

Squires RH et al (2012) Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium. J Pediatr 161(4):723–728 e2CrossRefPubMedPubMedCentral

Vanderhoof JA, Young RJ (2003) Enteral and parenteral nutrition in the care of patients with short-bowel syndrome. Best Pract Res Clin Gastroenterol 17(6):997–1015CrossRefPubMed

Demehri FR et al (2015) Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis. J Pediatr Surg 50(1):131–135CrossRefPubMed

Torres CVJ (2005) Short bowel syndrome, 4th edn. In: Bankhead R, Rolandelli RH, Boullata JI, Compher CW (eds) Clinical nutrition: enteral and tube feeding. Elsevier Saunders, Philadelphia

Torres C (2012) Clinical management of intestinal failure. In: Duggan CP, Jaksic T (eds) Clinical management of intestinal failure. CRC Press Taylor and Francis Group, Boca Raton, pp 107–115

Bianchi A (2007) Autologous gastrointestinal reconstruction for short bowel syndrome. Br J Hosp Med (Lond) 68(1):24–27CrossRef

Bianchi A (2006) From the cradle to enteral autonomy: the role of autologous gastrointestinal reconstruction. Gastroenterology 130(2 Suppl 1):S138–S146CrossRefPubMed

Wood SJ et al (2013) Early structured surgical management plan for neonates with short bowel syndrome may improve outcomes. World J Surg 37(7):1714–1717CrossRefPubMed

10.

Torres C et al (2007) Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr 45(2):204–212CrossRefPubMed

11.

Chahine AA, Ricketts RR (1998) A modification of the Bianchi intestinal lengthening procedure with a single anastomosis. J Pediatr Surg 33(8):1292–1293CrossRefPubMed

12.

Sehgal S et al (2018) Ostomy in continuity: a novel approach for the management of children with complex short bowel syndrome. J Pediatr Surg 53(10):1989–1995CrossRefPubMed

13.

Nusinovich Y, Revenis M, Torres C (2013) Long-term outcomes for infants with intestinal atresia studied at Children’s National Medical Center. J Pediatr Gastroenterol Nutr 57(3):324–329CrossRefPubMed

14.

Walker SR et al (2006) The Bianchi procedure: a 20-year single institution experience. J Pediatr Surg 41(1):113–119 (discussion 113–9) CrossRefPubMed

15.

Khalil BA et al (2012) Intestinal rehabilitation and bowel reconstructive surgery: improved outcomes in children with short bowel syndrome. J Pediatr Gastroenterol Nutr 54(4):505–509CrossRefPubMed

16.

Reinshagen K et al (2008) Long-term outcome in patients with short bowel syndrome after longitudinal intestinal lengthening and tailoring. J Pediatr Gastroenterol Nutr 47(5):573–578CrossRefPubMed

17.

Jones BA et al (2013) Report of 111 consecutive patients enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: a retrospective observational study. J Am Coll Surg 216(3):438–446CrossRefPubMedPubMedCentral

18.

Leung MW et al (2012) Serial transverse enteroplasty for short bowel syndrome: Hong Kong experience. Hong Kong Med J 18(1):35–39PubMed

19.

Lourenco L et al (2012) Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome. Eur J Pediatr 171(8):1265–1268CrossRefPubMed

20.

Oliveira C, de Silva N, Wales PW (2012) Five-year outcomes after serial transverse enteroplasty in children with short bowel syndrome. J Pediatr Surg 47(5):931–937CrossRefPubMed

21.

Javid PJ et al (2013) Intestinal lengthening and nutritional outcomes in children with short bowel syndrome. Am J Surg 205(5):576–580CrossRefPubMed

22.

Cowles RA et al (2007) Serial transverse enteroplasty in a newborn patient. J Pediatr Gastroenterol Nutr 45(2):257–260CrossRefPubMed

23.

Modi BP et al (2006) Serial transverse enteroplasty for management of refractory d-lactic acidosis in short-bowel syndrome. J Pediatr Gastroenterol Nutr 43(3):395–397CrossRefPubMedPubMedCentral

24.

Frongia G et al (2013) Comparison of LILT and STEP procedures in children with short bowel syndrome—a systematic review of the literature. J Pediatr Surg 48(8):1794–1805CrossRefPubMed

25.

Bianchi A (1984) Intestinal lengthening: an experimental and clinical review. J R Soc Med 77(Suppl 3):35–41PubMedPubMedCentral

26.

Ehrlich PF, Mychaliska GB, Teitelbaum DH (2007) The 2 STEP: an approach to repeating a serial transverse enteroplasty. J Pediatr Surg 42(5):819–822CrossRefPubMed

27.

Morikawa N et al (2009) Repeat STEP procedure to establish enteral nutrition in an infant with short bowel syndrome. Pediatr Surg Int 25(11):1007–1011CrossRefPubMed

28.

Bianchi A (1997) Longitudinal intestinal lengthening and tailoring: results in 20 children. J R Soc Med 90(8):429–432CrossRefPubMedPubMedCentral

29.

Bueno J et al (2001) Analysis of patients with longitudinal intestinal lengthening procedure referred for intestinal transplantation. J Pediatr Surg 36(1):178–183CrossRefPubMed

30.

Bianchi A (1999) Experience with longitudinal intestinal lengthening and tailoring. Eur J Pediatr Surg 9(4):256–259CrossRefPubMed

Titel: Autologous intestinal reconstruction: a single institution study of the serial transverse enteroplasty (STEP) and the longitudinal intestinal lengthening and tailoring (LILT)
verfasst von: Adil A. Shah
Mikael Petrosyan
Ashanti L. Franklin
Alfred A. Chahine
Clarivet Torres
Anthony D. Sandler
Publikationsdatum: 13.03.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 6/2019
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-019-04468-3

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Autologous intestinal reconstruction: a single institution study of the serial transverse enteroplasty (STEP) and the longitudinal intestinal lengthening and tailoring (LILT)