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Skipped aganglionic lengthening transposition (SALT) for short bowel syndrome in patients with total intestinal aganglionosis: technical report and feasibility

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Abstract

Extended aganglionosis (TIA) is the presence of some viable aganglionic gut distal to the levelling jejunostomy. Different surgical procedures (including transplantation) have been proposed with inconclusive results. We conceived a new procedure named skipped aganglionic lengthening transposition (SALT) consisting of multiple pedicled isoperistaltic transpositions of aganglionic ileal loops interposed to normoganglionic jejunum. The innovative aspect consists of taking advantage of the propulsive effect of normoganglionated bowel to progress enteric content throughout interposed aganglionic loops down to the stoma. The procedure was adopted in a male patient who was born with 30 cm of normoganglionated jejunum. SALT was performed when the baby was 18 months. Three 5-cm pedicled isoperistaltic aganglionic loops of small bowel were interposed each 10 cm of normoganglionic jejunum with an overall 36% length gain (from 42 to 57 cm). Postoperative course was uneventful. 6 months postoperatively, an upper gastrointestinal series showed normal progression without dilatations. A laparoscopic gastrostomy was performed due to food aversion 6 months postoperatively, demonstrating impressive anatomic and functional postoperative results. The procedure provides promising and unique opportunity for patients with TIA with encouraging outlook for the near future.

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Funding

This research was not supported by any funding.

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Authors and Affiliations

  1. Umberto Bosio Center for Digestive Diseases, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, EU, Italy

    A. Pini Prato, M. G. Faticato, I. Falconi, E. Felici, G. Casaccia, M. Caraccia & P. Nozza

  2. Unit of Minimally Invasive and Robotic Surgery, Department of Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza di Sant’Onofrio, 4, 00165, Rome, Italy

    A. Pini Prato

Authors
  1. A. Pini Prato
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  2. M. G. Faticato
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  3. I. Falconi
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  4. E. Felici
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  5. G. Casaccia
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  6. M. Caraccia
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  7. P. Nozza
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Contributions

APP conceived the idea of the procedure, mounted the video and recorded audio track; lead the original draft; MGF and IF equally lead the revision of the draft; GC and PN supported in conceiving the original draft; MC assessed the patients’ nutritional status.

Corresponding author

Correspondence to A. Pini Prato.

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All authors declare that they have nothing to disclose.

Ethics in research

This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was deemed unnecessary.

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The patient singed an informed consent regarding the procedure. Consent for publication was not required as long as information were anonymized, and submission does not include images that may identify the person.

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Pini Prato, A., Faticato, M.G., Falconi, I. et al. Skipped aganglionic lengthening transposition (SALT) for short bowel syndrome in patients with total intestinal aganglionosis: technical report and feasibility. Pediatr Surg Int 36, 1507–1510 (2020). https://doi.org/10.1007/s00383-020-04763-4

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  • DOI: https://doi.org/10.1007/s00383-020-04763-4

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