Abstract
Early bowel lengthening procedure (EBLP) has been defined as any bowel lengthening procedure performed before six months of age. The purpose of this paper is to compare our experience with literature on this subject to identify common indications. A bi-institutional retrospective analysis was performed. Diagnosis, type of surgery, age at procedure and outcomes were analysed. Eleven EBLP were performed in Manchester and Florence from 2006 to 2021. The median age at surgery was 126 days (102–180), pre-operative median short bowel (SB) length was 28 cm (17–49) with a post-operative median increase of 81%. Furthermore, a PubMed/Embase search was undertaken regarding bowel lengthening procedures performed in the last 40 years. Sixty-one EBLP were identified. The median age was 60 days (1–90). Serial transverse enteroplasty (STEP) was the most frequent procedure used, with a median increased bowel length of 57%. This study confirms that no clear consensus on indication or timing to perform early SB lengthening is reported. According to the gathered data, EBLP should be considered only in cases of actual necessity and performed in a qualified intestinal failure centre.
Highlights
Accepted: 3 February 2022Short bowel syndrome (SBS) is a severe multi-systemic disorder resulting from losing a significant amount of small bowel
The breakdown of the type of lengthening procedures performed at the hospital were: three longitudinal intestinal lengthening and tailoring (LILT), three Serial transverse enteroplasty (STEP), three spiral intestinal lengthening and tailoring technique (SILT), one LILT
Pre-operative median short bowel (SB) length was cm (17–49), while post-operative median SB length was 51 cm (25–70), with a median increased bowel length of 81%
Summary
Short bowel syndrome (SBS) is a severe multi-systemic disorder resulting from losing a significant amount of small bowel. The incidence of severe SBS is estimated to be. 25/100,000 live births; most sufferers are infants and young children [1]. The debate about the correct definition of SBS is still open. Bowel length of less than half expected for gestational age is considered abnormal [2]. The most frequent causes of SBS are necrotizing enterocolitis (NEC), small intestinal volvulus in intestinal malrotation, gastroschisis and small bowel atresia. In SBS, the residual intestine is inadequate to permit absorption/digestion of nutrients to maintain body weight, transit time is shortened, absorption of nutrients becomes ineffective and malnutrition, dehydration and electrolyte deficiency can develop [4]
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