Autologous intestinal reconstructive surgery to reduce bowel dilatation improves intestinal adaptation in children with short bowel syndrome.
OBJECTIVE
Intestinal failure (IF) is a common consequence of neonatal small bowel pathology. In our experience, bowel dilatation is often responsible for the IF state in patients who fail to adapt despite adequate residual bowel length. The aim of the present study was to investigate the role of surgery to reduce bowel dilatation, and thus favour PN independence, for these children.


METHODS
Data were collected prospectively for all of the patients referred to our unit for a 7-year period (2004-2011). Eight patients (2 congenital atresia, 2 gastroschisis with atresia, 1 simple gastroschisis, 3 necrotising enterocolitis) with gut dilatation who failed adaptation despite a bowel length >40 cm were identified. Preoperatively, all patients were totally dependent on parenteral nutrition (PN). Patients were managed by longitudinal intestinal lengthening and tailoring (n = 3), serial transverse enteroplasty (n = 2), or tapering enteroplasty (n = 3).


RESULTS
Median age at time of surgery was 273 days (103-1059). Mean gut length increased from 51 (35-75) to 73 cm (45-120) following surgery (P = 0.02). Incidence of sepsis (P = 0.01) and peak serum bilirubin levels (P = 0.005) were reduced postoperatively. PN was discontinued after a median of 110 days (35-537) for 7 patients; 1 patient remains on PN 497 days after surgery.


CONCLUSIONS
These data indicate that reconstructive surgery to reduce bowel diameter may be an effective technique for treating IF in patients with short bowel syndrome, without sacrificing intestinal length. We suggest that this technique may reduce the need for bowel transplantation in this group of patients.
Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK. sarah.l.almond@gmail.com
Sarah L
SL
Almond
Zeni
Z
Haveliwala
Basem
B
Khalil
Antonino
A
Morabito
D052636:Allostasis; D002675:Child, Preschool; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000209:etiology / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000637:transplantation; D008297:Male; D009929:Organ Size; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous