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Management of Short Bowel Syndrome After Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
In patients with an extensive bowel resection, intestinal adaptation may be insufficient to achieve enteral autonomy. Severely dilated and dysmotile small bowel develops, and enteral tolerance may plateau or even regress. For these patients, a number of surgical solutions have been devised with the primary goal of increasing functional absorptive surface area and improving motility. In 1980, Adrian Bianchi developed the first of these operations, known as the longitudinal intestinal lengthening and tailoring (LILT) procedure, in which the dilated segment of bowel is longitudinally divided and tubularized, with each half retaining its own vascularized mesenteric leaflet; the two segments are next anastomosed end to end to effectively double the length and halve the diameter. Multiple small case series have demonstrated efficacy in improving nutritional status in select patients; however, complication rates are high and include bowel devascularization and anastomotic stricture (6).
Growth of Intestinal Neomucosa on Pedicled Gastric Wall Flap, a Novel Technique in an Animal Model
Published in Journal of Investigative Surgery, 2022
Panagiotis Sakarellos, Apostolos Papalois, Harikleia Gakiopoulou, Iro Zacharioudaki, Michalis Katsimpoulas, Marina Belia, Dimitrios Moris, Kyveli Aggelou, Ilias Vagios, Spiridon Davakis, Michail Vailas, Theodoros Liakakos, Theodoros Diamantis, Evangelos Felekouras, Michael Kontos
To overcome these adversities, a few surgical procedures attempting to increase the effective intestinal surface have been proposed. Intestinal lengthening procedures are only indicated if there is sufficient bowel dilatation [5, 9–11]. The Bianchi technique or LILT (Longitudinal Intestinal Lengthening and Tailoring) and the serial transverse enteroplasty or STEP have stood the test of time in providing considerable improvement in enteral nutritional autonomy in around 60% of eligible cases [5, 12–15]. In SBS without dilatation attempts for ‘mechanically’ delaying transit (nipple valves, reversed bowel segments, colon interposition) have had equivocal outcomes [5, 16, 17].