320.9: The Double-Barrel Enteroplasty: A Novel Intestinal Lengthening Procedure for Short Bowel Syndrome

Abstract

Advances in the management of Short bowel syndrome (SBS) has resulted in children with shorter lengths of small bowel coming off TPN and achieving enteral autonomy. Although existing bowel lengthening procedures such as the Bianchi Longitudinal Intestinal Lengthening and Tailoring (LILT) procedure and Serial Transverse Enteroplasty (STEP) have enjoyed moderated degrees of success, they have not been without complications and better alternatives are still being sought after. We present our experience with a novel bowel-lengthening procedure for SBS termed the double-barrel enteroplasty (DBE) that is simpler to perform, is less disruptive to anatomy and has the potential to achieve similar to superior results to existing bowel lengthening procedures. Methods: Ten patients have undergone the DBE at the Children’s Hospital at Westmead between January 2011 and November 2018. Baseline characteristics, complications, time to TPN weaning and growth parameters were recorded prospectively. Results: The mean age at operation was 21 months (range 4–41 months). Mean pre-operative small bowel length was 74.6cm (36-167cm) with a mean length of 35.6cm (17-60cm) undergoing enteroplasty. Mortality and progression to transplantation remains zero. Six patients have achieved complete enteral autonomy within 2.8 months (0.5–5 months). The most recent patients are still weaning TPN. All patients have normalising growth parameters. One patient required an extension of the DBE for on-going proximal dilatation. Discussion: The DBE is a safe, effective and potentially superior alternative to existing bowel lengthening procedures for SBS. Advantages include its simplicity to perform, less disruption of bowel and mesentery, less anastomoses, decreased possibility of stenosed segments and maintenance of neuromuscular integrity.