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

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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.

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, Children’s National Health System, Washington, DC, USA

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

  2. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA

    Adil A. Shah

  3. Department of Gastroenterology, Hepatology, and Nutrition, Children’s National Health System, Washington, DC, USA

    Clarivet Torres

Authors
  1. Adil A. Shah
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  2. Mikael Petrosyan
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  3. Ashanti L. Franklin
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  4. Alfred A. Chahine
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  5. Clarivet Torres
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  6. Anthony D. Sandler
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Corresponding author

Correspondence to Mikael Petrosyan.

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The authors have no conflicts of interest to report.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Not applicable. Institutional review board (IRB) exemption was obtained for this retrospective chart review.

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Shah, A.A., Petrosyan, M., Franklin, A.L. et al. Autologous intestinal reconstruction: a single institution study of the serial transverse enteroplasty (STEP) and the longitudinal intestinal lengthening and tailoring (LILT). Pediatr Surg Int 35, 649–655 (2019). https://doi.org/10.1007/s00383-019-04468-3

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  • DOI: https://doi.org/10.1007/s00383-019-04468-3

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