Long-term outcome in patients with short bowel syndrome after longitudinal intestinal lengthening and tailoring.
OBJECTIVE
Longitudinal intestinal lengthening and tailoring (LILT) is a well-established surgical treatment for short bowel syndrome. It has been shown to enhance peristalsis, decrease bacterial overgrowth, and extend mucosal contact time for nutrients. We present the results of a long-term follow-up of patients who underwent LILT and define prognostic parameters for the survival of these patients.


METHODS
Between 1987 and 2006, 53 patients underwent LILT in our institution. The main diagnoses were gastroschisis, intestinal volvulus, intestinal atresias, and necrotizing enterocolitis. LILT was performed at a mean age of 24 months (range 4144 months). The follow-up time was 79.76 months (range 6234 months).


RESULTS
After LILT, 41 of 53 patients survived, and 36 of 41 surviving patients were successfully weaned from parenteral nutrition (PN). In long-term follow-up 79% stayed free of PN. The overall survival rate was 77.36%. Weight gain occurred in 58% of the patients after LILT. The quality of life after LILT is on a high level, with most patients having normal physical strength and participating in normal social life and education. Prognostic factors for survival after LILT in short bowel syndrome are length of small intestine (0.06582 + 0.0131 x bowel cm), length of large bowel (P = 0.039), preoperative liver function, and successful weaning from PN within 18 months postoperatively (P = 0.0032).


CONCLUSIONS
Patients undergoing LILT in short bowel syndrome have a high survival rate, weight gain, and a high quality of life. Autologous gastrointestinal reconstruction remains therefore the first choice in the treatment of patients with short bowel syndrome.
Reinshagen
K
K
Department of Pediatric Surgery, Klinikum Mannheim gGmbH, Mannheim, Germany. Konrad.Reinshagen@kch.ma.uni-heidelberg.de
Kabs
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Wirth
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Hable
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Brade
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Zahn
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Hagl
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Jester
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Waag
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KL
D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000503:physiopathology / Q000601:surgery; D007421:Intestine, Small / Q000033:anatomy & histology / Q000473:pathology; D007422:Intestines / Q000601:surgery*; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome