Neonatal Serial Transverse Enteroplasty (STEP): Case Report

Lobos, Pablo; Calello, S.E.M.; Busoni, Verónica; Lino, M.M. Urquizo; Prodan, Silvana; Clariá, Rodrigo Sanchez

doi:10.1016/j.transproceed.2015.12.062

Cited by 8 publications

(2 citation statements)

References 14 publications

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“…Even if an end ostomy was performed, the discrepancy of the diameter in the two sides in the second anastomosis will still be significant, which might lead to a funnel-shaped anastomosis, which would increase the risk of anastomotic fistula, prone to anastomotic obstruction, and delay digestive autonomy, even to reoperation, et al one increase the difficulty of anastomosis during the second surgery. In the situation wherein the proximal bowel is sufficiently dilated and bowel resection is not possible, exteriorization with later attempted closure is advisable ( 23 ). However, if the dilated intestinal area is near the duodenojejunal junction, a high output would be faced inevitably; this issue can be resolved by the Santulli procedure perfectly.…”

Section: Discussionmentioning

confidence: 99%

The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions

Yue

Yang²,

Cui³

et al. 2023

Front. Pediatr.

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BackgroundAs an end stoma, Santulli enterostomy provides early restoration of intestinal continuity without formal laparotomy. Short amputation of the common limb enables closure on a side to restore anatomic continuity without sacrificing valuable intestine; additionally, the procedure is simple and safe. Most newborns who require enterostomy might benefit from Santulli enterostomy; however, several pediatric surgeons lack information regarding this procedure. Therefore, we have reviewed our experience about Santulli enterostomy and explore the advantages and indications in neonatal intestinal conditions.MethodsThe clinical data of 76 neonates who underwent enterostomywere obtained. The patients were divided into two groups: the Santulli group with 33 cases who underwent Santulli enterostomy, and the control group with 43 cases who underwent double- or single-lumen ostomy. The general data of the two groups were analyzed, and the perioperative/postoperative complications, clinical data and the long-term outcomes were compared.ResultsThere was no difference in the demographic informations, the level of enterostomy, the rate of high-sight stoma, the operative time and bleeding of enterostomy between the two groups. Compared to the control group, the operative time of ostomy closure was less in the Santulli group (53.00 vs. 152.47, P < 0.001). The duration of parenteral nutrition (27.45 vs. 44.56, P = 0.010), the mean interval of initial enterostomy to stomal closure (131.21 vs. 216.42, P < 0.001), and length of stay (46.00 vs. 67.60, P = 0.007) were shorter, while the incidence of postoperative complications and hospitalization costs (11.21 vs. 15.49, P = 0.006) were lower. The Santulli procedure can reduce the morbidity of high output ostomy (2 vs. 10, P = 0.042) and short bowel syndrome (3 vs. 132, P = 0.025), shorten the discrepancy of diameter between the proximal and distal segments, maximize the available intestine, and monitor the movement of the distal bowel. The length of incision was shorter, and the catch-up growth was significantly faster in the Santulli group.ConclusionSantulli enterostomy is a superior procedure in the treatment of neonatal intestinal conditions, in terms of fewer complications, faster catch-up growth, shorter hospitalization time and treatment duration. It should be the procedure of choice in several newborns with intestinal conditions that require ostomy.

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Section: Discussionmentioning

confidence: 99%

The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions

Yue

Yang²,

Cui³

et al. 2023

Front. Pediatr.

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“…In total, the 10 papers [11,[15][16][17][18][19][20][21][22][23] reported 26 neonates (median gestational age of 36 ± 2.6 weeks) which underwent STEP procedure in the neonatal period (Table 1). Of note, SB atresia accounted for nearly two-thirds of the primary diagnosis, gastroschisis, with or without intestinal atresia, was the diagnosis in almost all of the remaining cases and midgut volvulus was reported in one case only (Figure 2).…”

Section: Introductionmentioning

confidence: 99%

“First STEP” or Nature Deserves a Second Chance! Systematic Literature Review and Meta-analysis

Aldeiri¹,

Coletta²,

Morabito³

2018

J Neonat Surg

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Aim: Surgical management of short bowel syndrome (SBS) in children is challenging. Recently, more authors are advocating for the neonatal serial transverse enteroplasty procedure (STEP) in SBS quoting the term “primary STEP” or “first STEP.” This review sought to identify the current published indications for neonatal STEP and to analyze their subsequent outcomes.Methods: We performed an OVID MEDLINE/ EMBASE search using the keywords: (Bowel, enteroplasty, intestinal lengthening, STEP, and short bowel) limited to children since the introduction of STEP in 2003 prospero systematic review registration number (CRD42017076955).Results: Thirteen papers matched our search criteria, and accurate data were available from 10 papers. A total of 26 cases had a STEP procedure at a median age of 2.5 days. The primary diagnosis was Jejunal atresia (62%), gastroschisis (19%), gastroschisis with atresia (15%), and midgut volvulus (4%). Almost a third (7/23) of the cases did not meet the anatomical definition of SBS and had a pre STEP residual small bowel (SB) length of ≥50 cm. Only 6 cases (26%) achieved enteral autonomy after the “first STEP,” interestingly in half the pre STEP SB length was ≥90 cm, 13 (56%) required a second STEP, 9 (40%) are still parenteral nutrition dependant, 4 more cases achieved enteral autonomy following a second STEP, 3 infants died, and one required SB transplantation. Significant post-operative complications were reported in four cases, and bowel redilatation occurred in almost all true SBS cases.Conclusion: Redilatation following “first STEP” is very common, may influence the ability to achieve enteral autonomy and generally necessitates further surgical intervention. The limited current evidence does not support the widespread use of STEP in the neonatal period. STEP can be a method of mucosal-sparing tailoring procedure; however, its outcomes in primary bowel lengthening in the neonatal period are yet to be established, and further studies are required before it is widely adopted.

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Double barrel enteroplasty for the management of short bowel syndrome in children

et al. 2020

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Neonatal Serial Transverse Enteroplasty (STEP): Case Report

Cited by 8 publications

References 14 publications

The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions

The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions

“First STEP” or Nature Deserves a Second Chance! Systematic Literature Review and Meta-analysis

Double barrel enteroplasty for the management of short bowel syndrome in children

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