Autologous Intestinal Reconstruction Surgery in Short Bowel Syndrome: Which, When, and Why

Abstract

Short bowel syndrome (SBS), secondary to any natural loss or after any extensive bowel resection for congenital malformations or acquired disease, is the most common cause of intestinal failure in children. Extensive introduction of parenteral nutrition (PN) has dramatically changed the outcome of these patients, allowing for long-term survival. The main goal in children with SBS remains to be increasing enteral tolerance and weaning from PN support. Post resection intestinal adaptation allows for achievement of enteral autonomy in a subset of these patients, but the inability to progress in enteral tolerance exposes others to long-term complications of PN. Autologous intestinal reconstruction surgery (AIRS) can facilitate the fulfilment of enteral autonomy, maximizing the absorptive potential of the remaining gut. All the different intestinal reconstruction techniques, from simple procedures like tapering, reversed segments, and colon interposition, to more complex lengthening procedures (LILT: longitudinal intestinal lengthening and tailoring, STEP: serial transverse enteroplasty, and SILT: spiral intestinal lengthening and tailoring) and techniques designed for peculiar problems like controlled intestinal tissue expansion or duodenal lengthening are presented. AIRS indications, clinical applications, and results reported in the literature are reviewed.

From waste to wealth: Repurposing slaughterhouse waste for xenotransplantation

“…Existing clinical strategies for intestinal and bladder substitution or reconstruction, which involve resection of damaged sections (Boroni et al, 2022) and the use of autologous segments of gastrointestinal tissue, in order to restore innate function (El-Taji et al, 2015;Chen et al, 2021), respectively, are prone to failure; therefore, novel alternative approaches are needed to address these issues. Advances in bioengineering are helping to engineer suitable scaffolds that can sustain the mechanical forces necessary for autonomic and sensory innervated peristaltic movements and filling and emptying (Serrano-Aroca et al, 2018).…”

Growing experience of surgical gut rehabilitation: essential role in the management of gut failure in adult patients

“…With a concept similar to that of STEP, bowel remodeling is also utilized to alleviate negative consequences. Excessive intestinal dilatation can be easily managed by simple tapering enteroplasty and plication of the antimesenteric border of dilated bowel [19][20][21][22].…”

Sustained elimination of parenteral support in adult patients with under 60 cm of small intestine: A case series

“…12 Autologous intestinal reconstruction helps facilitate enteral autonomy by creating uniform luminal diameter and improving absorption capacity of the gut. 12,13 A common procedure is the serial transverse enteroplasty (STEP). STEP is a series of staple firings in a zigzag pattern along a dilated portion of bowel to reduce the luminal diameter.…”

“…Autologous intestinal reconstruction procedures are indicated in the presence of intestinal dilation when attempts at medical management, enteral advancement, and/or PS weaning have failed 12 . Autologous intestinal reconstruction helps facilitate enteral autonomy by creating uniform luminal diameter and improving absorption capacity of the gut 12,13 . A common procedure is the serial transverse enteroplasty (STEP).…”