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Double barrel enteroplasty for the management of short bowel syndrome in children

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Abstract

Background

Currently, there are two well-established methods of bowel lengthening in patients with short bowel syndrome (SBS)-longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) [1–4]. Both procedures may carry a high reported morbidity and mortality of 30.2% and 14.4%, respectively [5]. We report the outcomes of a novel technique: double barrel enteroplasty (DBE) for autologous intestinal reconstruction.

Methods

We performed a retrospective review of all ten patients who underwent DBE at our institution since 2011. All patients have SBS and were dependent on parenteral nutrition (PN) at the time of surgery. Etiologies were gastroschisis (n = 4), bowel atresia (n = 3), necrotising enterocolitis (n = 1), volvulus (n = 1), and near-total intestinal aganglionosis (n = 1). Patient survival, complications, and subsequent enteral autonomy were evaluated.

Results

All patients are alive with normal liver function. Five children achieved enteral autonomy, while the remaining are on weaning PN. There was no bleeding, anastomotic leak, perforation, infective complications, or intestinal necrosis. No patient has required a liver and/or intestinal transplant.

Conclusions

Double barrel enteroplasty is technically feasible and safe. It has similar efficacy and may have fewer complications when compared with other methods of autologous intestinal reconstruction.

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Acknowledgements

We would like to thank Dr. Yann Polfrit, Pediatrician, Centre Hospitalier Territorial Gaston-Bourret, Noumea, New Caledonia and Dr. Scott Nightingale from the Department of Paediatric Gastroenterology, John Hunter Hospital in Newcastle, NSW, Australia, for follow-up care of patients 1, 2, and 5, respectively. Dr, Gordon Thomas provided the illustrations.

Funding

This research did not receive any grants from any public or private funding agencies.

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Authors and Affiliations

  1. Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, NSW, Australia

    Albert Shun, Gordon Thomas, Erik La Hei & Catherine Langusch

  2. Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia

    Albert Shun, Gordon Thomas, Erik La Hei & Catherine Langusch

  3. Department of Gastroenterology, The Children’s Hospital at Westmead, Westmead, NSW, Australia

    Juliana Puppi

  4. Department of Surgery, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia

    Albert Shun

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  1. Albert Shun
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  2. Gordon Thomas
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  3. Juliana Puppi
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  4. Erik La Hei
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  5. Catherine Langusch
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Contributions

All authors participated in the data acquisition, in patient care, and critical revision of the manuscript. The first draft of the manuscript was written in full by Albert Shun and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Albert Shun.

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Shun, A., Thomas, G., Puppi, J. et al. Double barrel enteroplasty for the management of short bowel syndrome in children. Pediatr Surg Int 37, 169–177 (2021). https://doi.org/10.1007/s00383-020-04767-0

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