Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

Abstract

Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.

Chronic Mucosal Inflammation in Pediatric Intestinal Failure Patients—A Unique Phenomenon

“…In the present study there was a higher prevalence of prior bowel lengthening procedures among the patients that developed chronic mucosal inflammation as compared to the controls. Lengthening procedures have been shown to increase the absorptive capacity and decrease the symptoms of small bowel bacterial overgrowth (25,26); however, numerous staple lines produced by serial transverse enteroplasties and the jejunocolic anastomosis may become loci for inflammation (27) and therefore should be taken into account in the long‐term surveillance of these patients…”

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

“…The latter include a variety of tissue-engineered small intestines (TESIs). TESI approaches range from small intestinal submucosa grafts to intestinal tissue repurposing with either stem cells or organoid units, the latter of which appears extraordinarily promising [ 163 , 167 , 168 , 169 , 170 ].…”

“…(6) Autologous gastrointestinal reconstruction operation: The aim of this procedure is to either enhance the mucosal surface area for absorption (e.g., lengthening procedures) or to slow intestinal transit to facilitate the assimilation of the nutrients or counterbalance stasis that cause gastrointestinal symptoms due to SIBO (e.g., reversing the segments of the intestine) [158,159], creating intestinal valves, or interposing a colonic segment in the mall intestinal remnant in either an isoperistaltic or antiperistaltic fashion [7,[160][161][162]. These procedures should only be used in carefully selected patients and in centers with proven experience [163][164][165].…”

Discrimination between normal and necrotic small intestinal tissue using hyperspectral imaging and unsupervised classification

“…If necrotic small intestine tissue is not completely removed during the surgery, it will lead to further deterioration of the necrotic tissue and the possibility of a second surgery. If a lot of small bowel tissue is removed, short bowel syndrome can occur and reduce the patient's future quality of life [15][16][17]. Currently, clinicians distinguish normal and necrotic areas of small bowel tissue based on visual observation.…”