Abstract
Based on the latest definition, short bowel syndrome is defined as intestinal failure due to the loss of significant small bowel length or function, when the homeostasis and growth can only be maintained with intravenous supplementation of fluid, electrolytes and macronutrients. The natural adaptation of the short bowel can only compensate for the loss up to a certain level. According to this, we differentiate (1) acute, (2) prolonged and (3) chronic types of intestinal failure/short bowel syndrome. The most common causes are necrotising enterocolits, intestinal malrotation and volvulus, gastroschisis and ileal atresia. The management of type 3 short bowel syndrome has evolved significantly during the last decades, due to the multidisciplinary approach, hence the survival and quality of life of the patients have improved and transplantation is rarely necessary. Our aim was to review the most important considerations of intestinal rehabilitation, like management of increased gastrin secretion, high output stoma, decreased transit time, central venous lines, enteral and parenteral nutrition and the enhancement of the natural adaptation. We reviewed the former and the latest options of the autologous intestinal reconstructive surgery (AIRS) like the reversed segment, small bowel interposition, ileocaecal valve replacement, bowel lengthening and tailoring (LILT, STEP and SILT), controlled bowel expansion and the latest results with distraction enterogenesis and tissue engineering. Orv Hetil. 2020; 161(7): 243-251.
Highlights
Based on the latest definition, short bowel syndrome is defined as intestinal failure due to the loss of significant small bowel length or function, when the homeostasis and growth can only be maintained with intravenous supplementation of fluid, electrolytes and macronutrients
The natural adaptation of the short bowel can only compensate for the loss up to a certain level
Our aim was to review the most important considerations of intestinal rehabilitation, like management of increased gastrin secretion, high output stoma, decreased transit time, central venous lines, enteral and parenteral nutrition and the enhancement of the natural adaptation. We reviewed the former and the latest options of the autologous intestinal reconstructive surgery (AIRS) like the reversed segment, small bowel interposition, ileocaecal valve replacement, bowel lengthening and tailoring (LILT, Serial transverse enteroplasty (STEP) and Spiral intestinal lengthening and tailoring (SILT)), controlled bowel expansion and the latest results with distraction enterogenesis and tissue engineering
Summary
A rövidbél-szindróma korszerű sebészi kezelése: autológ rekonstrukció és intestinalis rehabilitáció. A szerzők célja az intestinalis rehabilitáció legfontosabb szempontjainak – fokozott gasztrinszekréció, „high-output” stoma, csökkent tranzitidő, a centrális vénás kanülök ápolása, az enteralis, illetve parenteralis táplálás és az adaptáció serkentése – összegzése mellett a legújabb sebészi kezelési lehetőségek, köztük az autológ intestinalis rekonstrukció (AIRS) módszereinek, a passzázslassításnak (az ileocoecalis billentyű pótlása), a „bélhosszabbítás”-nak (LILT, STEP, SILT) és a felszívófelszínt növelő eljárásoknak (kontrollált bélexpanzió) az áttekintése volt. Our aim was to review the most important considerations of intestinal rehabilitation, like management of increased gastrin secretion, high output stoma, decreased transit time, central venous lines, enteral and parenteral nutrition and the enhancement of the natural adaptation We reviewed the former and the latest options of the autologous intestinal reconstructive surgery (AIRS) like the reversed segment, small bowel interposition, ileocaecal valve replacement, bowel lengthening and tailoring (LILT, STEP and SILT), controlled bowel expansion and the latest results with distraction enterogenesis and tissue engineering. A jelen összefoglaló célja a rövidbél-szindróma legújabb, multidiszciplináris kezelési szempontjainak áttekintése mellett a „non-trans plant” sebészeti autológ rekonstruktív eljárások irányvonalainak összegzése volt
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