Short Bowel Syndrome: A Practical Pathway Leading to Successful Enteral Autonomy

Ba’Ath, Muhammad Eyad; Almond, Sarah; King, B. A.; Bianchi, A.; Khalil, Basem A.; Morabito, Antonino

doi:10.1007/s00268-012-1512-5

Cited by 28 publications

(23 citation statements)

References 11 publications

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“…While these data cannot fully elucidate this relationship, the use of autologous intestinal reconstruction (e.g., serial transverse enteroplasty) for this indication has been reported and may represent some of the surgical burden in this group of patients. [11, 12, 13]…”

Section: Discussionmentioning

confidence: 99%

Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis

Khan

Mitchell

Fisher

et al. 2014

Journal of Pediatric Surgery

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Background Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown. Methods Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for > 60 days. Results 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0,6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (p<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3(1,6) versus 1 (0,3), respectively, p<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing > 2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment. Conclusions Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.

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Section: Discussionmentioning

confidence: 99%

Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis

Khan

Mitchell

Fisher

et al. 2014

Journal of Pediatric Surgery

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“…Tissue approximation during surgical procedures can be obtained by suturing or stapling [1][2][3][4]. Anastomotic leak is the most concerning complication as it can cause serious infection and need for further surgery [1][2][3][4]. Adhesive sealant creating chemical interaction with the substrate by the diffusion of molecules to the tissue, has been described.…”

Section: Introductionmentioning

confidence: 99%

Plasticised Regenerated Silk/Gold Nanorods Hybrids as Sealant and Bio-Piezoelectric Materials

et al. 2020

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Manual and mechanical suturing are currently the gold standard for bowel anastomosis. If tissue approximation fails, anastomotic leaks occur. Anastomotic leaks may have catastrophic consequences. The development of a fully absorbable, biocompatible sealant material based on a bio-ink silk fibroin can reduce the chance of anastomotic leaks. We have produced a Ca-modified plasticised regenerated silk (RS) with gold nanorods sealant. This sealant was applied to anastomosed porcine intestine. Water absorption from wet tissue substrate applied compressive strains on hybrid RS films. This compression results in a sealant effect on anastomosis. The increased toughness of the hybrid plasticised RS resulted in the designing of a bio-film with superior elongation at break (i.e., ≈200%) and bursting pressure. We have also reported structure-dependent piezoelectricity of the RS film that shows a piezoelectric effect out of the plane. We hope that in the future, bowel anastomosis can be simplified by providing a multifunctional bio-film that makes feasible the mechanical tissue joint without the need for specific tools and could be used in piezoelectric sealant heads.

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“…In this context, the purpose of the procedure is to improve the clinical situation prior to intestinal transplantation. 10,18 This supports the standpoint that SRT and intestinal transplantation are adjuvant therapies and not mutually exclusive, making the multidisciplinary assessment of each patient even more relevant.…”

Section: Mortality (%) 19%mentioning

confidence: 65%

Surgical Rehabilitation Techniques in Children with Poor Prognosis Short Bowel Syndrome

et al. 2015

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Intestinal failure (IF) requires a multidisciplinary management based on nutritional support, surgical and medical rehabilitation, and transplantation. The aim of this study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty, Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel syndrome (SBS) and poor prognosis due to complex abdominal pathology. We performed a single-center retrospective study of patients with IF evaluated for intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an SRT. Nonparametric tests were used for statistical analysis.A total of 205 patients (107 males/98 females) with mean age of 25 ± 7 months were assessed for IF. A total of 433 laparotomies were performed on 130 patients including intestinal resection, enteroplasties, adhesiolysis, and transit reconstruction. SRT were performed in 22 patients: 12 enteroplasties, 8 STEPs, and 4 Bianchi procedures. All patients were parenteral nutrition (PN) dependent with different stages of liver disease: mild (13), moderate (5), and severe (4). The adaptation rate for patients who underwent enteroplasty, STEP, and Bianchi were 70, 63, and 25%, respectively, although the techniques are not comparable. Overall, intestinal adaptation was achieved in nine (41%) patients, and four (18%) patients showed significant reduction of PN needs. One child did not respond to SRT and did not meet transplantation criteria. The remaining eight (36%) patients were included on the waiting list for transplant: four were transplanted, two are still on the waiting list, and two died. Better outcomes were observed in milder cases of liver disease (mild 77%, moderate 40%, severe 25%) (p < 0.05). Conversely, a trend toward a poorer outcome was observed in cases with ultrashort bowel (p > 0.05). One patient required reoperation after a Bianchi procedure due to intestinal ischemia and six needed further re-STEP or adhesiolysis procedure several months later. The median follow-up was 62 (3-135) months. Overall mortality was 19%, and was due to end-stage liver disease and/or central venous catheter-related sepsis. SRT led to intestinal adaptation in a significant number of patients with poor prognosis SBS referred for intestinal transplantation. However, SRT requires a multidisciplinary evaluation and should be attempted only in suitable cases. Careful assessment and optimal surgical timing is crucial to obtain a favorable outcome.

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Short Bowel Syndrome: A Practical Pathway Leading to Successful Enteral Autonomy

Abstract: We believe this improvement is related to the development-over many years-of a structured pathway for managing these patients.

Cited by 28 publications

References 11 publications

Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis

Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis

Plasticised Regenerated Silk/Gold Nanorods Hybrids as Sealant and Bio-Piezoelectric Materials

Surgical Rehabilitation Techniques in Children with Poor Prognosis Short Bowel Syndrome

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