Serial Transverse Enteroplasty Allows Children with Short Bowel to Wean from Parenteral Nutrition

Mercer, David F.; Hobson, Brandy D.; Gerhardt, Brandi K.; Grant, Wendy J.; Vargas, Luciano; Langnas, Alan Norman; Quirós-Tejeira, Rubén E.

doi:10.1016/j.jpeds.2013.08.039

Cited by 52 publications

(38 citation statements)

References 13 publications

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“…In the present study, operative and early postoperative complications were few, as expected from previous reports. 4 Also, liver enzymes and bilirubin had improved at follow-up compared with before STEP. Mortality was low, and the death in this series was not related to the STEP procedure.…”

Section: Discussionmentioning

confidence: 89%

“…The median maximal small bowel width was 5 cm. [2][3][4][5][6][7][8] A median number of 9 stapler firings (2-25) were used for the reconstruction. STEP made the small bowel 46% (0-233%) longer.…”

Section: Resultsmentioning

confidence: 99%

“…It has been reported that 33-88% of patients can be weaned off parenteral support after STEP. 4,[8][9][10][11][12][13][14][15] The patients who had undergone repeated STEP had a similar chance to be weaned off parenteral support compared with those who underwent only one STEP supporting active operative approach to redilatation. There were no significant differences between weight and height z scores before STEP and at follow-up.…”

Section: Discussionmentioning

confidence: 96%

“…Javid et al 14 showed that weight-for-age z score had increased at follow-up, whereas heightfor-age z score did not change significantly. Mercer et al 4 showed that height and weight z scores gradually increased during the first year after STEP. The increase in z score for weight became statistically significant 1 year after STEP.…”

Section: Discussionmentioning

confidence: 99%

“…This, in addition to symptoms of intestinal bacterial overgrowth and dysmotility such as diarrhea, vomiting, and/or D-lactic acidosis, is an indication to consider operative management. 3,4 Autologous intestinal reconstruction by a longitudinal intestinal lengthening and tapering procedure was first described by Bianchi serial transverse enteroplasty (STEP), a technically less challenging procedure, was introduced in 2003. 6,7 STEP has been shown to facilitate weaning from parenteral support in selected patients with short bowel syndrome, although repeated procedure is frequently required.…”

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confidence: 99%

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Absent ileocecal valve predicts the need for repeated step in children

Wester

Lilja

Stenström

et al. 2017

Surgery

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Background. Serial transverse enteroplasty facilitates weaning from parenteral support in selected patients with short bowel syndrome, although repeated procedure is frequently required. Our aim was to evaluate the outcome of a series of patients after serial transverse enteroplasty and define predictors of repeated serial transverse enteroplasty and weaning off parenteral support. Methods. All children who underwent serial transverse enteroplasty at 4 Nordic pediatric surgery centers from 2004-2015 were included in this observational study. Data were collected from the patient records. The study was approved by the local ethics review boards. Results. Twenty-seven children with short bowel with initial median small bowel length of 26 cm (range, 10-100 cm) were included. Eleven patients had the ileocecal valve remaining. Serial transverse enteroplasty was performed at median age of 7.5 months (range, 0.9-224 months). Serial transverse enteroplasty made the small bowel 46% (0-233%) longer. Eleven patients (41%) underwent a repeated serial transverse enteroplasty 12 months (1.0-72 months) later; 7 patients required additional operative procedures, but none were transplanted. At follow-up, 45.1 months (1.8-126 months) after the first serial transverse enteroplasty, 11 (41%) patients needed parenteral support. The remaining 16 patients had been weaned off parenteral support. One patient had died. Absence of the ileocecal valve was the only factor, which predicted the need for a repeated serial transverse enteroplasty (odds ratio 16.7, 95% confidence interval, 1.7-164.8, P = .007). No factor was identified predicting need for parenteral support at follow-up. Conclusion. A majority of children with short bowel syndrome can be weaned from parenteral support after serial transverse enteroplasty. The absence of the ileocecal valve predicts the need for a repeated serial transverse enteroplasty, which was required by 40% of the patients. (Surgery 2017;161:818-22.)

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Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Absent ileocecal valve predicts the need for repeated step in children

Wester

Lilja

Stenström

et al. 2017

Surgery

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Surgical considerations in the management of short bowel syndrome

Mercer

2023

Nut in Clin Prac

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Patients with short bowel syndrome (SBS) are optimally managed in centers of expertise with dedicated multidisciplinary intestinal failure (IF) teams. Over the life of a patient with SBS, many different surgical concerns may arise requiring intervention. These can range from reasonably simple procedures, such as the creation or maintenance of gastrostomy tube and enterostomies, to complex reconstructions of multiple enterocutaneous fistulas or the performance of intestine-containing transplants. This review will cover the development of a surgeon's role on the IF team; common surgical issues arising in patients with SBS, with a focus on decision-making rather than technique; and, finally, a brief overview of transplantation and some related decision-making issues.

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