Autologous intestinal reconstruction surgery for intestinal failure management.
OBJECTIVE
Multidisciplinary management of intestinal failure has progressed over the past 30 years, facilitating the transition to enteral autonomy in many pediatric patients. However, there remains a select group of patients who reach a plateau in advancement of their enteral nutrition. Numerous surgical options have been pursued to attempt to slow intestinal transit, taper dilated bowel, and promote intestinal adaptation. This review highlights the current literature on autologous intestinal reconstruction surgery, focusing on the two most commonly performed procedures, the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP).


RESULTS
LILT and STEP remain viable options to treat medically refractory short bowel syndrome. There is over 20 years of experience with the LILT procedure in the literature, with one large series showing that 67% of patients eventually transitioned to full enteral nutrition. The International STEP Data Registry reported a weaning rate of 34% after median follow-up of 12.6 months. Repeat STEP has been described as a possible treatment for the redilation that occurs after both LILT and STEP.


CONCLUSIONS
LILT and STEP may facilitate enteral feeding advancement in patients with medically refractory short bowel syndrome.
Jones
Brian A
BA
Center for Advanced Intestinal Rehabilitation, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
Hull
Melissa A
MA
Kim
Heung Bae
HB
D000222:Adaptation, Physiological; D013505:Digestive System Surgical Procedures; D004750:Enteral Nutrition; D006801:Humans; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012778:Short Bowel Syndrome / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome