Long-Term Outcomes After Autologous Intestinal Reconstructive Surgery in Children With Short Bowel Syndrome

Abstract

Objectives: Autologous intestinal reconstructive (AIR) surgery is frequently utilized in the management of pediatric short bowel syndrome (SBS). However, little is known about the long-term sequela of these procedures. Methods: We undertook a retrospective follow-up study addressing parenteral nutrition (PN) dependence, nutritional status, intestinal morbidity, and related complications in SBS patients having undergone AIR surgery (SBS-AIR, n = 19). We compared results with conservatively treated control SBS patients (SBS-C, n = 45). Eligible patients were identified from our institutional intestinal failure registry during 1985–2019. Results: After median 11.4 follow-up years, 42% of SBS-AIR patients received PN in relation to 36% in SBS-C group (P = 0.6210), and overall PN duration was significantly longer (35.4 vs 10 months, P = 0.0004) in SBS-AIR group. Although symptoms of intestinal dysfunction improved in majority (62%) of patients after AIR surgery, their symptoms remained more frequent and severe at latest follow-up compared to SBS-C group (39% vs 5%, P = 0.0015). Although bacterial overgrowth was more frequent in SBS-AIR group (53% vs 24%, P = 0.0416), latest endoscopy findings and fecal calprotectin levels as well as occurrence of anastomotic/staple line ulcerations were comparable between groups. Histological liver steatosis (50% vs 18%, P = 0.042) and impaired bone health (26% vs 6.7%, P = 0.042) were more frequent in SBS-AIR patients. Conclusions: While AIR surgery improved gastrointestinal symptoms and transition to enteral autonomy in majority of patients, a noteworthy proportion of them continued to suffer from clinically significant intestinal dysfunction and related complications. Close long-term follow-up of pediatric AIR surgery patients is mandatory.

Major surgical conditions of childhood and their lifelong implications: comprehensive review

“…Symptomatic dilatation resistant to antibiotic therapy may require tapering of an abnormally enlarged duodenal or small intestinal segment, not only to treat symptoms of SIBO by improving gut motility, but also to prevent liver injury by reducing bowel-derived bloodstream infections 52 , 53 , 66 . Although most patients wean off PN and experience improvement of their GI symptoms after AIR surgery, bowel dilatation and symptoms of intestinal dysfunction recur in a significant proportion of patients 52 , 53 , 67 . Intestinal inflammation and anastomotic ulcerations may cause intestinal bleeding, promoting recalcitrant iron deficiency anaemia, which may require parenterally infused iron supplementation 68 .…”

Cutoffs and Characteristics of Abnormal Bowel Dilatation in Pediatric Short Bowel Syndrome

“…Symptomatic bowel dilatation is commonly treated with autologous intestinal reconstructive (AIR) surgery, designed to reduce harmful dilatation while simultaneously increasing SB length and thereby improving bowel function and outcomes (5,12,15,16). However, correct patient selection for AIR surgery remains challenging as cutoff for abnormal harmful bowel dilatation remains unclear (17).…”