title: Autologous intestinal reconstruction surgery as part of comprehensive management of intestinal failure.
abstract: Pediatric intestinal failure (IF) remains to be associated with significant morbidity and mortality, the most frequent underlying etiologies being short bowel syndrome (SBS), and primary motility disorders. Management aims to assure growth and development, while preventing complications and facilitating weaning off parenteral support (PS) by fully utilizing adaptation potential of the remaining gut. Probability of survival and weaning off PS is improved by coordinated multidisciplinary intestinal rehabilitation combining individualized physiological enteral and parenteral nutrition (PN), meticulous central line care and medical management with carefully planned surgical care. Increasing evidence suggests that autologous intestinal reconstruction (AIR) surgery is effective treatment for selected short bowel patients. Bowel lengthening procedures normalize pathological adaptation-associated short bowel dilatation with potential to support intestinal absorption and liver function by various mechanisms. Although reversed small intestinal segment, designed to prolong accelerated intestinal transit, improves absorption in adult SBS, its feasibility in children remains unclear. Controlled bowel obstruction to induce dilatation followed by bowel lengthening aims to gain extra length in patients with the shortest duodenojejunal remnant. Reduced PS requirement limits the extent of complications, improving prognosis and quality of life. The great majority of children with SBS can be weaned from PS while prognosis of intractable primary motility disorders remains poor without intestinal transplantation, which serves as a salvage therapy for life-threatening complications such as liver failure, central vein thrombosis or recurrent bloodstream infections.
authors.affiliation: Section of Pediatric Surgery, Pediatric Liver and Gut Research Group Helsinki, Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 11, Po Box 281, 00029 HUS, Helsinki, Finland, Mikko.Pakarinen@hus.fi.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
mesh_terms: D064592:Autografts; D002648:Child; D019468:Disease Management; D004750:Enteral Nutrition; D005769:Gastrointestinal Motility; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery / Q000628:therapy*; D007422:Intestines; D010288:Parenteral Nutrition; D019651:Plastic Surgery Procedures / Q000379:methods*; D012778:Short Bowel Syndrome / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome
references.citation: Am J Clin Nutr. 2013 Jan;97(1):100-8
references.pmid: 23151533
references.citation: Gastroenterology. 1999 Nov;117(5):1043-50
references.pmid: 10535866
references.citation: Pediatr Res. 2009 May;65(5):559-63
references.pmid: 19127207
references.citation: Aliment Pharmacol Ther. 2011 Oct;34(8):1005-11
references.pmid: 21883325
references.citation: Am J Physiol Gastrointest Liver Physiol. 2014 Dec 15;307(12):G1147-68
references.pmid: 25342047
references.citation: Nutrients. 2012 Nov 27;4(12):1828-50
references.pmid: 23363993
references.citation: Am J Clin Nutr. 2014 Oct;100(4):1085-94
references.pmid: 25099547
references.citation: Hepatology. 2013 Aug;58(2):729-38
references.pmid: 23460496
references.citation: J Pediatr Gastroenterol Nutr. 2015 Feb;60(2):272-83
references.pmid: 25272324
references.citation: J Pediatr Gastroenterol Nutr. 2007 Mar;44(3):347-53
references.pmid: 17325556
references.citation: Gastroenterology. 2006 Feb;130(2 Suppl 1):S16-28
references.pmid: 16473066
references.citation: J Hepatol. 2015 Jun;62(6):1391-7
references.pmid: 25595885
references.citation: Hepatology. 2012 May;55(5):1518-28
references.pmid: 22120983
references.citation: J Hepatol. 2014 Jan;60(1):183-90
references.pmid: 24021426
references.citation: J Nutr. 2015 Feb;145(2):277-83
references.pmid: 25644348
references.citation: J Pediatr. 2001 Jul;139(1):27-33
references.pmid: 11445790
references.citation: Ann Surg. 1993 Oct;218(4):504-9; discussion 509-11
references.pmid: 8215641
references.citation: J Pediatr. 2005 Apr;146(4):542-7
references.pmid: 15812462
references.citation: Surgery. 2004 May;135(5):465-70
references.pmid: 15118580
references.citation: J Surg Res. 2011 Sep;170(1):27-31
references.pmid: 21601876
references.citation: Am J Clin Nutr. 1996 Aug;64(2):222-31
references.pmid: 8694024
references.citation: J Pediatr Gastroenterol Nutr. 2007 Aug;45(2):213-21
references.pmid: 17667718
references.citation: J Pediatr Surg. 2015 Feb;50(2):289-92
references.pmid: 25638621
references.citation: J Pediatr Gastroenterol Nutr. 2011 Oct;53(4):440-6
references.pmid: 21543999
references.citation: Ann Surg. 2007 Oct;246(4):593-601; discussion 601-4
references.pmid: 17893496
references.citation: J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):250-69
references.pmid: 15076623
references.citation: J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):118-26
references.pmid: 22820123
references.citation: J Pediatr Surg. 2010 Jan;45(1):95-9; discussion 99
references.pmid: 20105587
references.citation: Sci Transl Med. 2013 Oct 9;5(206):206ra137
references.pmid: 24107776
references.citation: Transplantation. 2008 May 15;85(9):1294-9
references.pmid: 18475187
references.citation: Am J Transplant. 2015 Jan;15(1):210-9
references.pmid: 25438622
references.citation: J Pediatr Surg. 2008 Jan;43(1):20-4
references.pmid: 18206449
references.citation: JPEN J Parenter Enteral Nutr. 2014 May;38(1 Suppl):23S-31S
references.pmid: 24586019
references.citation: J Pediatr. 2014 Jan;164(1):93-8
references.pmid: 24094877
references.citation: Scand J Gastroenterol. 2015 Mar;50(3):278-90
references.pmid: 25592555
references.citation: J Pediatr Surg. 2009 Jan;44(1):229-35; discussion 235
references.pmid: 19159748
references.citation: Ann Surg. 2012 Nov;256(5):739-44; discussion 744-5
references.pmid: 23095617
references.citation: J Pediatr. 2012 Oct;161(4):723-8.e2
references.pmid: 22578586
references.citation: Clin Nutr. 2015 Jun;34(3):428-35
references.pmid: 25015836
references.citation: J Pediatr Gastroenterol Nutr. 2014 Apr;58(4):438-42
references.pmid: 24231643
references.citation: Semin Pediatr Surg. 2014 Oct;23(5):291-7
references.pmid: 25459014
references.citation: J Pediatr Surg. 2013 Aug;48(8):1794-805
references.pmid: 23932625
references.citation: Semin Fetal Neonatal Med. 2011 Jun;16(3):157-63
references.pmid: 21398196
references.citation: J Pediatr Surg. 2009 May;44(5):933-8
references.pmid: 19433173
references.citation: World J Surg. 2013 Mar;37(3):694-704
references.pmid: 23232820
references.citation: J Pediatr Surg. 2013 May;48(5):993-9
references.pmid: 23701772
references.citation: Clin Nutr. 2013 Apr;32(2):162-71
references.pmid: 23159212
references.citation: Clin Nutr. 2013 Jun;32(3):368-74
references.pmid: 22992308
references.citation: J Pediatr. 2004 Aug;145(2):157-63
references.pmid: 15289760
references.citation: J Pediatr Surg. 2013 Feb;48(2):339-44
references.pmid: 23414862
references.citation: Gastroenterology. 2006 Feb;130(2 Suppl 1):S138-46
references.pmid: 16473062
references.citation: J Pediatr Surg. 2015 Mar;50(3):493-6
references.pmid: 25746715
references.citation: Ann Surg. 2005 Sep;242(3):403-9; discussion 409-12
references.pmid: 16135926
references.citation: Nutr Clin Pract. 2013 Feb;28(1):65-74
references.pmid: 23087264
references.citation: J Pediatr Gastroenterol Nutr. 2008 Nov;47(5):573-8
references.pmid: 18979580
references.citation: J Pediatr Surg. 2008 Oct;43(10):1833-8
references.pmid: 18926216
references.citation: Gastroenterology. 2012 Feb;142(2):355-65.e1-4
references.pmid: 22057115
references.citation: Ann Surg. 2006 Feb;243(2):223-8
references.pmid: 16432355
references.citation: J Pediatr Surg. 2013 Feb;48(2):333-8
references.pmid: 23414861
references.citation: J Pediatr Surg. 2014 Nov;49(11):1589-92
references.pmid: 25475799
references.citation: J Pediatr Surg. 2003 Jun;38(6):881-5
references.pmid: 12778385
references.citation: Surgery. 2015 Apr;157(4):732-42
references.pmid: 25704423
references.citation: Clin Nutr. 2015 Apr;34(2):171-80
references.pmid: 25311444
references.citation: J Pediatr Surg. 2015 Jan;50(1):131-5
references.pmid: 25598109
references.citation: Gut. 2011 Jan;60(1):17-25
references.pmid: 21068130
references.citation: Gastroenterology. 1993 Sep;105(3):791-8
references.pmid: 8359650
references.citation: World J Surg. 2011 May;35(5):1142-5
references.pmid: 21318429
references.citation: J Pediatr Surg. 2012 May;47(5):931-7
references.pmid: 22595576
references.citation: J Pediatr. 2008 Nov;153(5):674-6, 676.e1-2
references.pmid: 18589446
references.citation: J Pediatr Surg. 2011 Jan;46(1):145-9
references.pmid: 21238656
references.citation: J Pediatr Gastroenterol Nutr. 2012 Apr;54(4):505-9
references.pmid: 21832945
references.citation: J Pediatr Surg. 2004 May;39(5):690-5
references.pmid: 15137001
references.citation: JPEN J Parenter Enteral Nutr. 2014 May;38(1 Suppl):14S-22S
references.pmid: 24500909
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):803-11
references.pmid: 22197940
references.citation: J Pediatr Gastroenterol Nutr. 2013 Jan;56(1):36-9
references.pmid: 22744194
references.citation: J Pediatr Gastroenterol Nutr. 2008 Oct;47(4):450-7
references.pmid: 18852637
references.citation: J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):24-9
references.pmid: 25729889
references.citation: Scand J Gastroenterol. 2015 Feb;50(2):153-61
references.pmid: 25421304
references.citation: Gastroenterology. 2006 Feb;130(2 Suppl 1):S78-90
references.pmid: 16473077
references.citation: J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):588-93
references.pmid: 10554128
references.citation: J Pediatr. 1997 Sep;131(3):356-61
references.pmid: 9329409
references.citation: J Pediatr Surg. 2011 Jun;46(6):1045-51
references.pmid: 21683196
references.citation: J Pediatr. 2013 Nov;163(5):1361-6
references.pmid: 23866718
references.citation: Br J Surg. 2014 Sep;101(10):1329-33
references.pmid: 25043139
references.citation: JPEN J Parenter Enteral Nutr. 2014 May;38(1 Suppl):8S-13S
references.pmid: 24486858
references.citation: J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):267-70
references.pmid: 16878000
references.citation: JPEN J Parenter Enteral Nutr. 2014 Jan;38(1):70-85
references.pmid: 23894170
references.citation: Clin Nutr. 2012 Dec;31(6):831-45
references.pmid: 22658443
references.citation: J Pediatr Gastroenterol Nutr. 2013 Jun;56(6):631-4
references.pmid: 23343940
references.citation: J Am Coll Surg. 2013 Mar;216(3):438-46
references.pmid: 23357726
references.citation: J Pediatr Surg. 2013 May;48(5):983-92
references.pmid: 23701771
references.citation: J Pediatr Surg. 2009 May;44(5):939-43
references.pmid: 19433174
references.citation: JAMA Surg. 2014 Jul;149(7):663-70
references.pmid: 24827450