title: Intestinal rehabilitation and bowel reconstructive surgery:  improved outcomes in children with short bowel syndrome.
abstract: OBJECTIVE
  Short bowel syndrome poses a great challenge to pediatric teams. Several innovative techniques in the management of total parenteral nutrition (TPN) and bowel reconstructive surgery have improved the outcomes of these children. The authors present their experience during the last decade as a specialist unit using improved techniques and multidisciplinary approaches in the management of this condition.
  
  
  METHODS
  All of the children presenting with short bowel syndrome between 2000 and 2009 were identified. Diagnosis, length of residual gut, age at definitive surgery, length of gut prelengthening, length of gut postlengthening, TPN status, and survival were recorded. Median values were calculated.
  
  
  RESULTS
  Twenty-seven children were identified (14 boys, 13 girls). Overall survival was 92%. Two children died. Nineteen children required bowel lengthening and 8 children had simple bowel reconstruction while on our protocol. Overall median age at definitive surgery was 12 months. Overall median residual gut length for these was 35.5 cm, whereas the median residual gut length for patients undergoing bowel lengthening was 25 cm. Postbowel lengthening, the median gut length was 90 cm. TPN data were unavailable for 2 patients. Overall, excluding the 2 patients who died and the 2 we have no TPN data on, of 23 patients, 21 (91%) are now off TPN.
  
  
  CONCLUSIONS
  Our series shows improved results not only with survival but also in the number of patients that are off TPN. Multidisciplinary approach consisting of both medical and surgical expertise is necessary in the management of these patients. The authors advocate centralisation of short gut services to experienced centers with multidisciplinary expertise.
authors.affiliation: Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: Basem A
authors.initials: BA
authors.lastname: Khalil
authors.forename: Muhammad E
authors.initials: ME
authors.lastname: Ba'ath
authors.forename: Anuar
authors.initials: A
authors.lastname: Aziz
authors.forename: Lynette
authors.initials: L
authors.lastname: Forsythe
authors.forename: Sara
authors.initials: S
authors.lastname: Gozzini
authors.forename: Fiona
authors.initials: F
authors.lastname: Murphy
authors.forename: Gordon
authors.initials: G
authors.lastname: Carlson
authors.forename: Adrian
authors.initials: A
authors.lastname: Bianchi
authors.forename: Antonino
authors.initials: A
authors.lastname: Morabito
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000601:surgery*; D008297:Male; D010289:Parenteral Nutrition, Total / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012778:Short Bowel Syndrome / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome