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Intestinal Failure
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Rashmi Patil, Elizabeth King, Jeffrey Rudolph
A main priority of surgical management in intestinal failure is the maximal preservation of intestine, particularly small bowel. Intestinal sparing during the initial procedure by salvaging all viable intestine is key to optimizing long-term outcomes. However, inclusion of compromised bowel can also be a source of poor bowel function. Re-establishing bowel continuity through ostomy reversal is associated with improved enteral tolerance and a decreased risk of liver disease. A gastrostomy or gastrojejunostomy tube is often used to support EN. Surgical approaches to intestinal reconstruction such as serial transverse enteroplasty (STEP) and Bianchi lengthening procedures aim to increase the mucosal surface area available to enhance nutrient absorption, improve motility, and limit bacterial overgrowth. Lastly, intestinal transplantation may be offered to patients with little to no chance of enteral autonomy, recurrent or life-threatening catheter-related blood stream infections, loss of venous access, or severe intestinal failure-associated liver disease. Transplantation offers an alternative to lifelong dependence on PN, but is fraught with its own challenges including that of long-term graft survival.
Management of Short Bowel Syndrome After Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
The serial transverse enteroplasty procedure (STEP) was later developed by H. B. Kim in the early 2000s and has become the most popular procedure due to its technical ease. Dilated bowel segments are tapered and lengthened by firing linear staplers applied perpendicular to the intestine on the antimesenteric side alternating with the mesenteric side. Figure 17.1 illustrates this surgical therapy using before and after radiographs and operative photographs. A STEP can be repeated on bowel that redilates, which is an added benefit over the LILT operation. Rates of enteral autonomy approach 50% in retrospective studies; however, the true rates of success attributable to surgery versus natural history remain unclear, for there has not been a prospective randomized trial (6, 13).
Surgery of short bowel syndrome: Longitudinal intestinal lengthening and tailoring and serial transverse enteroplasty
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Riccardo Coletta, Sam M. Han, Charles R. Hong, Antonino Morabito, Tom Jaksic
The surgery of short bowel syndrome (SBS) has been designed to maximize the potential of the existing bowel and overcome the problems of proximal intestinal dilatation, impaired antegrade motility, and bacterial sumping and overgrowth. Modern surgical treatment can be said to have begun in 1980 when Adrian Bianchi designed the first effective method of bowel lengthening, now known as longitudinal intestinal lengthening and tailoring (LILT). This improved the chances of enteral autonomy and reduced the requirement for PN. An alternative procedure, serial transverse enteroplasty (STEP), was first described in a porcine model in 2003 and has also gained wide acceptance by pediatric surgeons both for the initial reconstruction of dilated bowel and for repeat surgery for redilation. The first human STEP was performed on a 2-year-old with SBS from gastroschisis and midgut volvulus who had previously undergone LILT.
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].
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Intestinal failure patients are at an increased risk for ulcers and GI bleeding resulting in significant morbidity and mortality. Contributing factors include SIBO, dysmotility, serial transverse enteroplasty procedure (STEP) and surgical anastomotic ulcers, ischemia, gastric acid hypersecretion, and inflammation [91,92]. Ulcers typically present with painless GI bleeding but can be associated with abdominal discomfort, pain, and blood in the stool. Diagnostic workup includes upper, lower, and video capsule endoscopy [91,92].