Absent ileocecal valve predicts the need for repeated step in children.
Serial transverse enteroplasty facilitates weaning from parenteral support in selected patients with short bowel syndrome, although repeated procedure is frequently required. Our aim was to evaluate the outcome of a series of patients after serial transverse enteroplasty and define predictors of repeated serial transverse enteroplasty and weaning off parenteral support.



All children who underwent serial transverse enteroplasty at 4 Nordic pediatric surgery centers from 2004-2015 were included in this observational study. Data were collected from the patient records. The study was approved by the local ethics review boards.



Twenty-seven children with short bowel with initial median small bowel length of 26 cm (range, 10-100 cm) were included. Eleven patients had the ileocecal valve remaining. Serial transverse enteroplasty was performed at median age of 7.5 months (range, 0.9-224 months). Serial transverse enteroplasty made the small bowel 46% (0-233%) longer. Eleven patients (41%) underwent a repeated serial transverse enteroplasty 12 months (1.0-72 months) later; 7 patients required additional operative procedures, but none were transplanted. At follow-up, 45.1 months (1.8-126 months) after the first serial transverse enteroplasty, 11 (41%) patients needed parenteral support. The remaining 16 patients had been weaned off parenteral support. One patient had died. Absence of the ileocecal valve was the only factor, which predicted the need for a repeated serial transverse enteroplasty (odds ratio 16.7, 95% confidence interval, 1.7-164.8, P = .007). No factor was identified predicting need for parenteral support at follow-up.



A majority of children with short bowel syndrome can be weaned from parenteral support after serial transverse enteroplasty. The absence of the ileocecal valve predicts the need for a repeated serial transverse enteroplasty, which was required by 40% of the patients.
Unit of Pediatric Surgery, Department of Women's and Children's Health, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden. Electronic address: tomas.wester@karolinska.se.
Tomas
T
Wester
Unit of Pediatric Surgery, Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
Helene Engstrand
HE
Lilja
Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden.
Pernilla
P
Stenström
Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Mikko
M
Pakarinen
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007080:Ileocecal Valve / Q000473:pathology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D012086:Reoperation; D012778:Short Bowel Syndrome / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome