Intestinal Bowel Lengthening in Children with Short Bowel Syndrome: Systematic Review of the Bianchi and STEP Procedures

Abstract

Outcomes for intestinal lengthening procedures are very good, and increasingly so. However, further analysis is required in order to fully understand the relative strengths and weaknesses of each procedure.

“Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel

“…The STEP procedure, reported by Kim in 2003, partially divides the dilated bowel transversely, serially and alternately in zigzag pattern using a transmesenteric approach with a possible increase in length of [100 % [7]. The STEP procedure [2,5] can be safely repeated in the event of recurrent significant bowel dilatation. A recent systematic review of both procedures by King et al [5] demonstrated a relatively low complication rate for obstruction, redilatation and perforation [1] at 17 % for the LILT Group and 26 % for the STEP group (p \ 0.02).…”

“…The STEP procedure [2,5] can be safely repeated in the event of recurrent significant bowel dilatation. A recent systematic review of both procedures by King et al [5] demonstrated a relatively low complication rate for obstruction, redilatation and perforation [1] at 17 % for the LILT Group and 26 % for the STEP group (p \ 0.02). While survival was higher for STEP patients (89 vs 81 %, p \ .001) this was probably due to the greater severity of the illness for the LILT group.…”

“…Children with the short bowel state and dilated bowel who undergo autologous gastrointestinal reconstruction have a propulsive bowel of longer length and reduced diameter that avoids stasis, enhances adaptation, and increases mucosal contact time with greater absorption [5]. Longitudinal intestinal lengthening and tailoring (LILT), described by Bianchi in 1980 and used successfully largely in children [6], divides the bowel along the mesenteric and antemesenteric borders to half its diameter and doubles its length with no loss of bowel, restoring effective propulsion and reducing stasis.…”

Short bowel syndrome in children: Surgical and medical perspectives

“…The data gathered suggested that the percentage of patients weaned was significantly higher in the LILT group than in the STEP group. 27 The most recent lengthening and tailoring technique described is called Spiral Intestinal Lengthening and Tailoring (SILT). 28 Briefly spiral incision lines are drawn with a sterile marking pen at 451-601 to the longitudinal axis of a dilated small bowel segment.…”

Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

“…2013 yılındaki bir derleme sonucunda hem Bianchi hem de STEP uygulamasının bağırsak yetmezlikli hastalarda önemli seçenekler oldukları ortaya konmuştur ( Tablo 7), (56,(83)(84)(85)(86) .…”