Surgical Management of Short Bowel Syndrome

Abstract

For patients with short bowel syndrome (SBS), surgery can play an important role in preventing, mitigating, and, in some cases, reversing intestinal failure (IF). During intestinal resection, bowel length should be conserved to the fullest extent possible to avoid dependence on parenteral nutrition (PN). Bowel salvage may be improved by initially preserving tissue of questionable viability and later reevaluating during “second‐look” procedures. Once the patient is stabilized, ostomy reversal and recruitment of distal unused bowel should be prioritized whenever feasible. Following progression to IF, surgical management of SBS depends on the symptoms and anatomical characteristics of the individual patient. For carefully selected patients with rapid intestinal transit and dilated bowel, longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) procedures may provide benefit. Outcomes following STEP and LILT are generally similar, and the choice between these procedures may rest on surgeon preference. For patients with rapid intestinal transit in the absence of bowel dilation, segmental reversal of the small bowel may reduce PN requirements. Intestinal transplantation is the standard of care for patients in whom intestinal rehabilitation attempts have failed and who are at risk of life‐threatening complications of PN. Because patients awaiting isolated intestine transplant show increased survival compared with patients awaiting combined intestine‐liver transplant, early referral of appropriate patients, before the development of advanced liver disease, is critical to enhancing patient outcomes.

Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome

“…Tapering surgery of dilated SB in order to relieve the related functional problems has become increasingly popular during recent years especially in pediatric patients [14][15][16][17][18][19][20]. In serial transverse enteroplasty (STEP) and longitudinal intestinal lengthening and tapering (LILT), SB length is increased by narrowing the dilated intestine while preserving all absorptive mucosal surface [19,21].…”

Surgical Options in Short Bowel Syndrome

“…Reversed segment lengths of 10-15 cm for adults and around 3 cm for children have been suggested to provide maximum benefits, but establishing the ideal length and location of the reversed bowel segment remains uncertain and produces variable results when clinically applied; e.g., this technique cannot be used when the remnant bowel is <25 cm [49]. For patients with rapid intestinal transit and who do not present bowel dilation, small bowel segmental reversal may cut PN requirements [49][50][51][52].…”

Clinical nutrition therapy in patients with short bowel syndrome in line with principles of personalized medicine

“…Ha nincs béltágulat, csökkenteni lehet a béltranzitidőt, valamint a bélmucosa felszínének növelése is lehetséges különböző sebészeti módszerekkel [17].…”