Duodenal lengthening in short bowel with dilated duodenum.
Although duodenal dilatation occurs in children with short bowel syndrome (SBS) facilitating dismotility and bacterial overgrowth, the duodenum has been an untouchable intestinal segment for lengthening procedures owing to its close relationship with bilio-pancreatic structures and blood supply shared with the pancreas. Three children (age range, 0.5-7 years) with SBS and dilated duodenum underwent a novel surgical procedure of duodenal lengthening combined with a technical modification of serial transverse enteroplasty (STEP). Pre-STEP, jejunum length was 5, 35 and 45cm, respectively. Duodenal lengthening was performed with sequential transverse applications of an endoscopic stapler on the anterior and posterior wall of the duodenum to avoid bilio-pancreatic structure injury. Two patients underwent 3 duodenal firings (stapler of 35mm) and the third 5 firings (stapler of 45mm). Duodenal firings were 17%, 21% and 83% of the total firings.


RESULTS
No surgical complications occurred. One patient developed transient episodes of D-lactic acidosis. Two patients (5 and 45cm) were weaned off parenteral nutrition at 12months post-surgery and the remaining patient´s (35cm) parenteral calorie requirements have decreased by 60%.


CONCLUSIONS
Duodenal lengthening is effective since it tailors and increases the absorptive surface of the duodenum, even in cases of extreme SBS.
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: jbueno@vhebron.net.
Javier
J
Bueno
Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Susana
S
Redecillas
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Laura
L
GarcÍa
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Alba
A
Lara
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Carlos
C
Giné
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
José A
JA
Molino
Digestive Surgery and Transplantation Unit, Pediatric Surgery Department, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Jesús
J
Broto
Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Oscar
O
Segarra
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic / Q000150:complications; D004386:Duodenum / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000473:pathology; D008297:Male; D010179:Pancreas / Q000098:blood supply; D010288:Parenteral Nutrition; D010289:Parenteral Nutrition, Total; D012778:Short Bowel Syndrome / Q000150:complications / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods
Autologous reconstructive surgery; Duodenal lengthening; Intestinal lengthening; Serial transverse enteroplasty; Short bowel syndrome; Surgical technique