Current Surgical Concepts and Indications in the Management of the Short Bowel State: A Call for the Use of Multidisciplinary Intestinal Rehabilitation Programs.

Antonino Morabito,Maria Chiara Cianci,Riccardo Coletta,Sara Ugolini

doi:10.3390/children8080654

Abstract

The mainstay of management for short bowel syndrome (SBS) is to promote access to the best quality of care provided by the intestinal rehabilitation program (IRP) in specialized centres. When treating SBS patients, the main goal is to minimize disease-associated complications, as well as achieve enteral autonomy. Surgical strategies should be selected cautiously upon the actual state of the bowel with respect to what it is clinically relevant for that specific patient. To this aim, a personalized and multidisciplinary approach for such a complex syndrome is needed.

Highlights

This has mainly been due to improved overall care, new total parenteral nutrition (TPN) formulas, and improved surgical techniques [4,5]
Bowel lengthening procedures have increasingly been proposed for long-term TPN patients who fail to improve intestinal function with non-invasive strategies and, in selected groups of patients, bowel transplantation can be an option to consider [6,8,9]
Starting from our own experience, according to the intestinal rehabilitation program (IRP), we aimed to review the available knowledge in order to delineate steps of management for autologous gastrointestinal reconstruction (AGIR) in general and lengthening procedures [10,11,12]

Summary

Introduction

The overall survival has increased over the last decades, even with significant losses of bowel length [3]. This has mainly been due to improved overall care, new total parenteral nutrition (TPN) formulas, and improved surgical techniques [4,5]. TPN complications are still a challenge for rehabilitation teams and long-term parenteral nutrition (PN) may lead to intestinal failure-associated liver disease (IFALD) [6,7]. Bowel lengthening procedures have increasingly been proposed for long-term TPN patients who fail to improve intestinal function with non-invasive strategies and, in selected groups of patients, bowel transplantation can be an option to consider [6,8,9]. The aim of non-transplant surgery is to restore normal (or close to normal) physiology by optimizing the absorptive surface area, improving peristalsis and decreasing transit time by reshaping morphology (i.e., narrowing and lengthening the bowel by taking advantage of pathologic dilatation)

Objectives

Findings

Discussion

Conclusion