title: Comparison of intestinal lengthening procedures for patients with short bowel syndrome.
abstract: OBJECTIVE
  Review the clinical results of 24 years of intestinal lengthening procedures at one institution.
  
  
  METHODS
  Retrospective review of a single center experience comparing the outcome of 2 intestinal lengthening procedures (Bianchi and serial transverse enteroplasty [STEP]) in terms of survival, total parenteral nutrition (TPN) weaning, and complications.
  
  
  RESULTS
  Sixty-four patients, including 14 adults, underwent 43 Bianchi and 34 STEP procedures between 1982 and 2007. Three patients had prior isolated liver transplants. The median (range) remnant bowel length before first lengthening was 45 (11-150) cm overall; (Bianchi=44 cm, STEP=45 cm) and 68 (20-250) cm after lengthening; (Bianchi=68 cm, STEP=65 cm). Actual survival is 91% overall (Bianchi 88%, STEP 95%) with median follow-up of 3.8 years (Bianchi=5.9 years, STEP=1.7 years). Average enteral caloric intake in pediatric patients was 15 kcal/kg before lengthening and 85 kcal/kg at 1 year after lengthening. Sixty-nine percent of patients are off TPN at most recent follow-up, including 8 who were weaned from TPN after intestinal transplantation. Liver disease (when present) was reversed in 80%. Surgical complications occurred in 10%, more commonly requiring reoperation after Bianchi than STEP. Intestinal transplantation salvage was required in 14% at a median of 2.9 years (range=8 months to 20.7 years) after lengthening.
  
  
  CONCLUSIONS
  Surgical lengthening with both Bianchi and STEP procedures results in improvement in enteral nutrition, reverses complications of TPN and avoids intestinal transplantation in the majority with few surgical complications. Intestinal transplantation can salvage most patients who later develop life-threatening complications or fail to wean TPN.
authors: Department of Surgery, Nebraska Medical Center, Omaha, Nebraska 68198-3285, USA. dsudan@unmc.edu
authors: Debra
authors: D
authors: Sudan
authors: Jon
authors: J
authors: Thompson
authors: Jean
authors: J
authors: Botha
authors: Wendy
authors: W
authors: Grant
authors: Dean
authors: D
authors: Antonson
authors: Steve
authors: S
authors: Raynor
authors: Alan
authors: A
authors: Langnas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000601:surgery* / Q000637:transplantation; D008107:Liver Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome