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Surgical strategies in short bowel syndrome

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Abstract

Extensive loss of small bowel in all age groups has significant morbidity and mortality consequences. Despite the astonishing ability of the small bowel to compensate for an extensive loss, long-term parenteral nutrition and enteral nutrition, tailored to the need of the patients in relation to the missing intestinal regions is needed. Organ-preserving surgical intervention becomes necessary in patients with a very short intestinal transit time and in an other group of patients with impaired propulsive peristalsis. Intestinal transplantation is indicated in recurrent septical infections or if nearly all of the small bowel is missing. This review discusses indications and risks of the organ-preserving surgical therapies in children with short bowel syndrome.

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References

  1. Toulukian RJ, Walker-Smith GJ (1983) Normal intestinal length in preterm infants. J Pediatr Surg 6:720–723

    Article  Google Scholar 

  2. Struijs MC, Diamond IR, de Slva N et al (2009) Establishing norms for intestinal length in children. J Pediatr Surg 44:933–938

    Article  PubMed  Google Scholar 

  3. Rickham PP (1967) Massive intestinal resection in newborn infants. Ann R Coll Surg 41:480–485

    CAS  Google Scholar 

  4. Höllwarth ME, Granger DN, Ulrich-Baker MG et al (1988) Pharmacologic enhancement of adaptive growth after extensive small bowel resection. Pediatr Surg Int 3:55–61

    Google Scholar 

  5. D’Antiga L, Goulet O (2013) Intestinal failure in children: the European view. JPGN 56:118–126

    PubMed  Google Scholar 

  6. Goulet O, Ruemmele F (2006) Causes and management of intestinal failure. Gastroenterology 130:S16–S28

    Article  CAS  PubMed  Google Scholar 

  7. Pironi L (2016) Definition of intestinal failure and the short bowel syndrome. Best Praxis Clin Gastroenterol 30:173–185

    Article  Google Scholar 

  8. Schalamon J, Schober PH, Gallippi P et al (1990) Congenital short bowel: a case study and review of the literature. Eur J Pediatr Surg 2:248–250

    Google Scholar 

  9. Mughal M, Irving M (1986) Home parenteral nutrition in the United Kingdom and Ireland. Lancet 2:383–387

    Article  CAS  PubMed  Google Scholar 

  10. Van Gossum A, Bakker H, Bozetti F et al (1999) Home parenteral nutrition in adults: a European multicenter study in 1997. Clin Nutr 18:135–140

    Article  Google Scholar 

  11. Wallander J, Ewald U, Lackgren G et al (1992) Extreme short bowel syndrome in neonates: an indication for small bowel transplantation. Transpl Proc 24:1230–1235

    CAS  Google Scholar 

  12. Wales PW, De Silva N, Kim J et al (2004) Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates. J Pediatr Surg 39:690–695

    Article  PubMed  Google Scholar 

  13. Cole CR, Hansen NI, Higgins RD et al (2008) Very low birth weight preterm infants with surgical short bowel syndrome: incidence, morbidity and mortality, and growth outcomes at 18 to 22 month. Pediatrics 122:e573–e582

    Article  PubMed  PubMed Central  Google Scholar 

  14. Salvia G, Guarino A, Terrin G et al (2008) Neonatal onset intestinal failure: an Italian multicenter study. J Pediatr 153:674–676

    Article  PubMed  Google Scholar 

  15. Höllwarth M (2014) Short bowel syndrome in childhood. In: Granger DN, Granger JP (eds) Colloquium series in integrated systems physiology: from molecule to function to disease, vol 50. Morgan & Claypool Life Sciences

  16. Coran AG, Spivak D, Teitelbaum DH (1999) An analysis of the morbidity and mortality of short bowel syndrome in the pediatric age group. Eur J Pediatr Surg 9:228–230

    Article  CAS  PubMed  Google Scholar 

  17. Schimpl G, Feierl G, Linni K et al (1999) Bacterial translocation in the short bowel syndrome in rats. Eur J Pediatr Surg 9:224–227

    Article  CAS  PubMed  Google Scholar 

  18. Goulet O, Baglin-Gobet S, Talbotec C (2005) Outcome and long-term growth after extensive small bowel resection in the neonatal period: a survey of 87 children. Eur J Pediatr Surg 15:95–101

    Article  CAS  PubMed  Google Scholar 

  19. Demehri FR, Stephens L, Herrman E et al (2015) Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis. J Pediatr Surg 50:131–135

    Article  PubMed  Google Scholar 

  20. Cywes S (1968) The surgical management ofmassive bowel resection. J Pediatr Surg 3:740–748

    Article  Google Scholar 

  21. Gibson LD, Carter R, Hinshaw DB (1962) Segmental reversal of small intestine after massive bowel resection. Successful case with follow-up examination. JAMA 182:952–954

    Article  CAS  PubMed  Google Scholar 

  22. Trinkle JK, Bryant LR (1967) Reversed colon segment in an infant with massive small bowel resection: a case report. J Kentucky Med Assoc 65:1090–1091

    CAS  Google Scholar 

  23. Kurz R, Sauer H (1983) Treatment and metabolic findings in extreme short bowel syndrome with 11 cm jejunal remnant. J Pediatr Surg 18:257–263

    Article  CAS  PubMed  Google Scholar 

  24. Panis Y, Messing B, Rivet P et al (1997) Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome. Ann Surg 225:401–407

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Beyer-Berjot L, Joly F, Maggiori L et al (2012) Segmental reversal of the small bowel can end permanent nutrition dependency. An experience of 38 adults with short bowel syndrome. Ann Surg 256:739–745

    Article  PubMed  Google Scholar 

  26. Layec S, Beyer L, Corcos O et al (2013) Increased intestinal absorption by segmental reversal of the small bowel in adult patients with short-bowel syndrome: a case control study. Am J Clin Nutr 97:100–108

    Article  CAS  PubMed  Google Scholar 

  27. Thompson JS (2016) Reversed intestinal segment revisited. Transplant Proc 48:453–456

    Article  CAS  PubMed  Google Scholar 

  28. Puri P, Höllwarth ME (2006) Short bowel syndrome. In: Puri P, Höllwarth ME (eds) Pediatric Surgery. Springer, Heidelberg, pp 257–274

    Chapter  Google Scholar 

  29. Ricotta J, Zuidema GD, Gadacz TR et al (1981) Construction of an ileocecal valve and its role in massive resection of the small intestine. Surg Gynecol Obstet 152:310–314

    CAS  PubMed  Google Scholar 

  30. Zurita M, Raurich JM, Ramirez A et al (2004) A new neovalve type in short bowel syndrome surgery. Rev Esp Enfem Dig 96:110–118

    CAS  Google Scholar 

  31. Georgeson K, Halpin D, Figueroa R et al (1994) Sequential intestinal lengthening procedures for refractory short bowel syndrome. J Pediatr Surg 29:316–320

    Article  CAS  PubMed  Google Scholar 

  32. Lloyd DA (1978) Colonic interposition between the jejunum and ileum after massive bowel resection in rats. Prog Pediatr Surg 12:51–106

    CAS  PubMed  Google Scholar 

  33. Sidhu GS, Narasimharao KL, Rani VU et al (1984) Morphological and functional changes in the gut after massive small bowel resection and colon interposition in the rhesus monkeys. Digestion 29:47–54

    Article  CAS  PubMed  Google Scholar 

  34. King DR, Anvari M, Jamieson GG et al (1996) Does the colon adapt small bowel features in a small bowel environment. Aus N Z J Surg 66:543–546

    Article  CAS  Google Scholar 

  35. Noordgard I, Hansen BST, Mortensen PB (1996) Importance of colonic support for energy ansorption in small-bowel failure proceeds. Am J Nutr 64:222–231

    Google Scholar 

  36. Goulet O, Colomb-Jung V, Joly F (2009) Role of the colon in short bowel syndrome and intestinal transplantation. JPGN 48(Suppl 2):S66–S71

    PubMed  Google Scholar 

  37. Kono K, Sekikawa T, Iizuka H et al (2001) Interposed colon between remnants of the small intestine exhibits small bowel features in a patient with short bowel syndrome. Dig Surg 18:237–241

    Article  CAS  PubMed  Google Scholar 

  38. Garcia VF, Templeton JM, Eichelberger MR et al (1981) Colon interposition for the short bowel syndrome. J Pediatr Surg 16:994–995

    Article  CAS  PubMed  Google Scholar 

  39. Glick PL, de Lorimier AA, Azdick NS et al (1984) Colon interposition: an adjuvant operation for the short gut syndrome. J Pediatr Surg 19:719–725

    Article  CAS  PubMed  Google Scholar 

  40. Brolin RE (1986) Colon interposition for extreme short bowel syndrome: a case report. Surgery 100:576–580

    CAS  PubMed  Google Scholar 

  41. Almond SL, Haveliwala Z, Khalil B et al (2013) Autologous intestinal reconstructive surgery to reduce bowel dilatation improves intestinal adaptation in children with short bowel syndrome. JPGN 56:631–634

    PubMed  Google Scholar 

  42. Thompson J, Sudan D (2008) Intestinal lengthening for short bowel syndrome. Adv Surg 42:49–61

    Article  PubMed  Google Scholar 

  43. Bianchi A (1980) Intestinal loop lengthening—a technique for increasing small intestinal length. J Pediatr Surg 15:145–151

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  45. Aigrain Y, Cornet D, Cezard JP et al (1985) Longitudinal division of small intestine: a surgical possibility for children with very short bowel syndrome. Z Kinderchir 40:233–236

    CAS  PubMed  Google Scholar 

  46. Ba‘ath ME, Almond S, King B et al (2013) Short bowel syndrome: a practical pathway leading to successful enteral autonomy. World J Surg 36:1044–1048

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  48. Bianchi A (1997) A longitudinal intestinal lengthening and tailoring: rsults in 20 children. J R Soc Med 90:429–432

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Walker SR, Nucci A, Yaworski JA et al (2006) The Bianchi procedure: a 20-years single institution experience. J Pediatr Surg 41:113–119

    Article  PubMed  Google Scholar 

  50. Thompson JS, Pinch LW, Young R et al (2000) Long-term outcome of intestinal lengthening. Transplant Proc 32:1242–1243

    Article  CAS  PubMed  Google Scholar 

  51. Vernon AH, Georgeson KE (2001) Surgical options for short bowel syndrome. Semin Pediatr Surg 10:91–98

    Article  CAS  PubMed  Google Scholar 

  52. Kim HB, Lee PW, Garza J et al (2003) Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 38:881–885

    Article  PubMed  Google Scholar 

  53. Bueno J, Redecillas S, Garcia L et al (2015) Duodenal lengthening in short bowel with dialted duodenum. J Pediatr Surg 50:493–496

    Article  PubMed  Google Scholar 

  54. Alberti D, Boroni G, Gianotti G et al (2014) “Spiral intestinal lengthening and tailoring (SILT)” for a child with severly short bowel. Pediatr Surg Int 30:1169–1172

    Article  PubMed  Google Scholar 

  55. Javid PJ, Sanchez SE, Hoersien SP et al (2013) Intestinal lengthening and nutritional outcomes in children with short bowel syndrome. Am J Surg 205:576–580

    Article  PubMed  Google Scholar 

  56. Jones BA, Hull MA, Potanos KM 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 216:438–446

    Article  PubMed  PubMed Central  Google Scholar 

  57. Mercer DF, Hobson BD, Gerhardt BK et al (2014) Serial transverse enteroplasty allows children with chort bowel to wean from parenteral nutrition. J Pediatr 164:93–98

    Article  PubMed  Google Scholar 

  58. Fernandes MA, Usatin D, Allen IE et al (2016) Improved enteral tolerance following step procedure: systematic literature review and meta-analysis. Pediatr Surg Int 32:921–926

    Article  PubMed  Google Scholar 

  59. Sudan D, Thompson J, Botha J et al (2007) Comparison of intestinal lengthening procedures for patients with short bowel syndrome. Ann Surg 246:593–604

    Article  PubMed  Google Scholar 

  60. Hommel MJ, van Baren R, Haveman JW (2016) Surgical management and autolous intestinal reconstruction in short bowel syndrome. Best Pract Res Clin Gastroenterol 30:263–280

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  62. Miyasaka EA, Brown PI, Teitelbaum DH (2011) Redilatation of bowel after intestinal lengthening procedures—an indicator of poor outcome. J Pediatr Surg 46:145–149

    Article  PubMed  Google Scholar 

  63. Pakarinen MP, Kurvinen A, Koisuvalo AI et al (2013) Long-term controlled outcomes after autologous reconstructive surgery in treatment of severe short bowel syndrome. J Pediatr Surg 48:339–344

    Article  PubMed  Google Scholar 

  64. Kang KH, Gutierrez IM, Zurakowski D et al (2012) Bowel re-dilatation following serial transverse enteroplasty (STEP). Pediatr Surg Int 28:1189–1193

    Article  PubMed  Google Scholar 

  65. Hukkinen M, Kivisaari R, Merras-Salmio L et al (2016) Small bowel dilatation predicts prolonged parenteral nutrition and decreased survival in pediatric short bowel syndrome. Ann Surg. doi:10.1097/SLA.0000000000001893

    PubMed  Google Scholar 

  66. Ives GC, Demehri FR, Sanchez R et al (2016) Small bowel diameter in short bowel syndrome as a predictive factor for achieving enteral autonomy. J Pediatr. doi:10.1016/j.jpeds.2016.08.007

    PubMed  Google Scholar 

  67. Printz H, Schlenzka R, Requadt O et al (1997) Small bowel lengthening by mechanical distraction. Degestion 58:240–248

    Article  CAS  Google Scholar 

  68. Safford SD, Freemerman AJ, Safford KM et al (2005) Longitudinal mechanical tension induces growth in the small bowel of juvenile rats. Gut 54:1085–1990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Luntz J, Brei D, Teitelbaum D et al (2006) Mechanical extension implants for short bowel syndrome. Proc SPIE Int Soc Opr Eng 6173:61739

    Google Scholar 

  70. Shekherdimian S, Mohanchandra K, Panduranga K et al (2010) The feasibility of using endoluminal device for intestinal lengthening. J Pediatr Surg 45:1575–1580

    Article  PubMed  Google Scholar 

  71. Scott A, Rouch JD, Huynh N et al (2016) Mechanical lengthening in multiple intestinal segments in-series. J Pediatr Surg 51:757–759

    Google Scholar 

  72. Sueyoshi R, Woods KM, Okawada M et al (2014) Distraction-induced intestinal growth: the role of mechanotransduction mechanisms in a mouse model of short bowel syndrome. Tissue Eng 20:830–841

    CAS  Google Scholar 

  73. Shirafkan A, Montalbano M, McGuire J et al (2016) New approaches to increase intestinal length: methods used for intestinal regeneration and bioengineering. World J Transplant 6:1–9

    Article  PubMed  PubMed Central  Google Scholar 

  74. Grant CN, Molica SG, Sala FG et al (2015) Human and mouse tissue-engineered small intestine both demonstrate digestive and absorptive function. Am J Physiol Gasrointest Liver Physiol 308:G664–G677

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. University Clinic for Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 36, 8034, Graz, Austria

    Michael. E. Höllwarth

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  1. Michael. E. Höllwarth
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Correspondence to Michael. E. Höllwarth.

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Höllwarth, M.E. Surgical strategies in short bowel syndrome. Pediatr Surg Int 33, 413–419 (2017). https://doi.org/10.1007/s00383-016-4043-6

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