The Surgical Approach to Short Bowel Syndrome - Autologous Reconstruction versus Transplantation.
BACKGROUND
Short bowel syndrome (SBS) is a state of malabsorption resulting from massive small bowel resection leading to parenteral nutrition (PN) dependency. Considerable advances have been achieved in the medical and surgical management of SBS over the last few decades.


METHODS
This review discusses in detail the surgical approach to SBS.


RESULTS
Widespread use of PN enables long-term survival in patients with intestinal failure but at the cost of PN-associated life-threatening complications including catheter-associated blood stream infection, venous thrombosis, and liver disease. The goal of management of intestinal failure due to SBS is to enable enteral autonomy and wean PN by means of a multi-disciplinary approach. Availability of modified enteral feeding formulas have simplified nutrition supplementation in SBS patients. Similarly, advances in the medical field have made medications like growth hormone and glucagon-like peptide (GLP2) available to improve water and nutrient absorption as well as to enable achieving enteral autonomy. Autologous gastrointestinal reconstruction (AGIR) includes various techniques which manipulate the bowel surgically to facilitate the bowel adaptation process and restoration of enteral nutrition. Ultimately, intestinal transplantation can serve as the last option for the cure of intestinal failure when selectively applied.


CONCLUSIONS
SBS continues to be a challenging medical problem. Best patient outcomes can be achieved through an individualized plan, using various AGIR techniques to complement each other, and intestinal transplantation as a last resort for cure. Maximum benefit and improved outcomes can be achieved by caring for SBS patients at highly specialized intestinal rehabilitation centers.
Division of Transplantation, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Aparna
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Rege
AGIR; Autologous gastrointestinal reconstruction; LILT; Longitudinal intestinal lengthening and tailoring; PN; Parenteral nutrition; SBS; STEP; Serial transverse enteroplasty; Short bowel syndrome; USBS; Ultra-short bowel syndrome