Repeat surgical bowel lengthening with the STEP procedure.
BACKGROUND
Feasibility of repeat lengthening has been demonstrated in animals, but in humans, none of the three clinical case reports have achieved enteral autonomy after secondary lengthening with serial transverse enteroplasty (STEP).


METHODS
Institutional Review Board approved retrospective review of a single center series of repeat intestinal lengthening after prior Bianchi lengthening or STEP. Outcome measures examined include patient survival, weaning from parenteral nutrition, and need for intestinal transplantation.


RESULTS
Repeat lengthening with STEP was performed 16 times in 14 patients including 2 adults and 7 male patients after prior Bianchi (n=7) and prior STEP (n=7). Median time after initial lengthening to reSTEP was 12 months (2 months-15 years). Median remnant bowel length before initial lengthening was 35 cm (15-110), before reSTEP was 56.5 cm (27-100) and final length after reSTEP was 90 cm (39-120). Survival is 100% with a median follow-up of 14.5 months (1-65 months). Discontinuation of parenteral nutrition (PN) after reSTEP was achieved in 6 of 14 (43%) patients at a median of 3 months (0.5-13 months) after reSTEP. Intestinal transplant salvage was performed in four patients at 7, 9, 13 months, and 4.6 years, respectively, after reSTEP. All four of those undergoing intestinal transplantation have also subsequently discontinued PN.


CONCLUSIONS
Repeat lengthening is technically feasible after either of the available surgical lengthening procedures (Bianchi and STEP). In the stable patient, who is unable to wean from PN, repeat lengthening led to discontinuation of TPN in almost half of these carefully selected patients and does not preclude intestinal transplantation.
Andres
Ane M
AM
University of Nebraska Medical Center, Transplant Surgery, 983285 Nebraska medical Center, Omaha, NE 68198-6555, USA.
Thompson
Jon
J
Grant
Wendy
W
Botha
Jean
J
Sunderman
Brandy
B
Antonson
Dean
D
Langnas
Alan
A
Sudan
Debra
D
D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000601:surgery* / Q000637:transplantation; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012778:Short Bowel Syndrome / Q000601:surgery*
D012709:Serum Albumin; D001663:Bilirubin