Serial Transverse Enteroplasty Research Articles

Serial Transverse Enteroplasty (STEP) versus Longitudinal Intestinal Lengthening and Tailoring (LILT): Systematic Review and Meta-Analysis of Outcomes and Complications

Abstract Background The prevalence of SBS is 3-4 per million. It occurs in about 15% of adult patients who undergo intestinal resection, with 3/4th of these cases resulting from massive intestinal resection and 1/4th from multiple sequential resections. About 70% of patients in whom SBS develops are discharged from the hospital and a similar percentage remain alive a year later. This improved survival rate has been achieved primarily by the ability to deliver long-term nutritional support. Objective To compare between Serial Transverse Enteroplasty (STEP) and Longitudinal Intestinal Lengthening and Tailoring (LILT) in the incidence of complications and clinical prognosis regarding morbidity and mortality in patients with Short Bowel Syndrome (SBS). Patients and Methods The search was carried out using the electronic national library of medicine PubMed database, Cochrane library and manual reference of articles published on serial transverse enteroplasty (STEP) versus longitudinal intestinal lengthening and tailoring (LILT) in management of patients with SBS. Conclusive search was done and duplicate studies were excluded. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available on the Internet till 2022. Results LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently, it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. There is very limited published data on bowel lengthening procedure exclusively in adults. Most reported series exclusively or predominantly discuss the pediatric population with some adults included in one series and two additional single case reports. Conclusion Both STEP and LILT are potentially safe and effective methods for the treatment of SBS, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed. This review should be a gateway to open the scope on the field of Autologous Intestinal Reconstruction Surgeries (AIRS) and plan for a more detailed prospective studies with close monitoring of the data regarding outcomes, complications and follow up.

Segmental Intestinal Reconfiguration (SIR) in Combined Reconstructions for Ultrashort Bowel Syndrome

BackgroundUltrashort bowel syndrome represents the most rare and complex variant of the short bowel syndrome. Autologous intestinal reconstructions for ultrashort bowel syndrome is typically reserved for severe cases characterized by symptomatic dysmotility within the ultrashort dilated segments. Limited surgical techniques are available to substantially increase the length of ultrashort bowels with asymmetric and highly dilated segments.We present a case series detailing the application of a technique for lengthening and tapering significantly dilated ultrashort bowels – segmental intestinal reconfiguration (SIR), based on the Yang-Monti principle. Our analysis delves into the technical features across various anatomical variants and provides mid-term results. MethodsFrom 2021 to 2022, patients experiencing dysmotility in dilated ultrashort bowel segments with a preserved colon underwent sequential combined intestinal reconstructions. Assessments were conducted 18–24 months post-surgery, and statistical calculations employed nonparametric methods to compare pre- and postoperative results. ResultsSix patients, with a median age of 48.5 months, underwent autologous intestinal reconstructions, including SIR. The serial transverse enteroplasty (STEP) was performed on the dilated duodenum in five children, and colon interposition in two. The length of the small bowel exhibited a significant difference before and after surgery (p=0.031). No complications were observed in the postoperative period. The postoperative group demonstrated a lower dependence on parenteral nutrition (NPEI/REE < 80% in 6 (100.0%); p=0.007). Enteral autonomy was restored in two children. ConclusionsThe results of SIR technique in combined reconstructions for ultrashort bowel syndrome in a carefully selected cohort of children demonstrate feasibility and reliability, as well as the restoration of intestinal transport function at midterm evaluation. This comprehensive approach resulted in increased enteral tolerance and reduced parenteral requirements.

Segmental Intestinal Reconfiguration (SIR) in Combined Reconstructions for Ultrashort Bowel Syndrome

BackgroundUltrashort bowel syndrome represents the most rare and complex variant of the short bowel syndrome. Autologous intestinal reconstructions for ultrashort bowel syndrome is typically reserved for severe cases characterized by symptomatic dysmotility within the ultrashort dilated segments. Limited surgical techniques are available to substantially increase the length of ultrashort bowels with asymmetric and highly dilated segments.We present a case series detailing the application of a technique for lengthening and tapering significantly dilated ultrashort bowels – segmental intestinal reconfiguration (SIR), based on the Yang-Monti principle. Our analysis delves into the technical features across various anatomical variants and provides mid-term results. MethodsFrom 2021 to 2022, patients experiencing dysmotility in dilated ultrashort bowel segments with a preserved colon underwent sequential combined intestinal reconstructions. Assessments were conducted 18–24 months post-surgery, and statistical calculations employed nonparametric methods to compare pre- and postoperative results. ResultsSix patients, with a median age of 48.5 months, underwent autologous intestinal reconstructions, including SIR. The serial transverse enteroplasty (STEP) was performed on the dilated duodenum in five children, and colon interposition in two. The length of the small bowel exhibited a significant difference before and after surgery (p=0.031). No complications were observed in the postoperative period. The postoperative group demonstrated a lower dependence on parenteral nutrition (NPEI/REE < 80% in 6 (100.0%); p=0.007). Enteral autonomy was restored in two children. ConclusionsThe results of SIR technique in combined reconstructions for ultrashort bowel syndrome in a carefully selected cohort of children demonstrate feasibility and reliability, as well as the restoration of intestinal transport function at midterm evaluation. This comprehensive approach resulted in increased enteral tolerance and reduced parenteral requirements.

Fallo intestinal crónico secundario a síndrome de intestino corto: papel actual de la cirugía, la rehabilitación médica y el trasplante intestinal. Informe evolutivo a 16 años de manejo multidisciplinario

decades, medical treatments and surgical procedures have been incorporated, developed and improved under the name intestinal rehabilitation. When performed by multi- and interdisciplinary teams, these treatments have high success rates. Objective: The aim of present study is to describe the 16-year outcomes in the management of patients with CIF secondary to short bowel syndrome (SBS) and the role of surgery, medical rehabilitation, and transplantation. Material and methods: We conducted a retrospective analysis on a prospective database of patients treated with chronic intestinal failure due to SBS between February 2006 and March 2022. Results: A total of 492 patients (368 adults (Group A) and 124 pediatric patients (Group B)] were included. Group A: 111 patients underwent autologous gastrointestinal reconstruction surgery (AGIRS), 16 were treated with semisynthetic glucagon-like peptide-2 (sGLP2); 83% achieved rehabilitation, with 77% survival at 10 years; 6.8% (17 patients) required intestinal transplantation (ITx), with 89% independence from parenteral nutrition (PN) at 1 year and post-ITx survival of 29% at 10 years. Group B: 18 patients underwent AGIRS; 9 underwent serial transverse enteroplasty (STEP); and 6 received sGLP2; 52% were rehabilitated, with 69% survival at 10 years; 28 patients received ITx, with 69% independence from PN at 1 year and 39% survival at 10 years. Conclusion: These results highlight the central role of surgery and medical rehabilitation in the recovery of intestinal function.

Short Bowel Syndrome in neonates and early infancy

Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.

Intestinal Bowel Lengthening within the First 6 Months of Life: Institutional Experience and Review of the Literature.

Management of short bowel syndrome in children has been surrounded by much debate with timing of the lengthening procedure still controversial. Early bowel lengthening procedure (EBLP) has been defined as any bowel lengthening procedure performed before 6 months of age. The purpose of this paper is to report the institutional experience in EBLP and to review the literature on this subject to identify common indications. An institutional retrospective analysis of all the intestinal lengthening procedures was performed. Furthermore, an Ovid/Embase search regarding children who underwent bowel lengthening in the past 38 years was conducted. Primary diagnosis, age at procedure, type of procedure, indication, and outcome were analyzed. Ten EBLP were performed in Manchester from 2006 to 2017. Median age at surgery was 121 days (102-140), preoperative small bowel (SB) length was 30 cm (20-49) while postoperative SB length was 54 cm (40-70), with a median increased bowel length of 80%. Ninety-seven papers were reviewed, with more than 399 lengthening procedures performed. Twenty-nine papers matched criteria with more than 60 EBLP were observed of which 10 were performed in a single center from 2006 to 2017. EBLP was performed due to SB atresia, to excessive bowel dilatation or failure to enteral feeds, at a median age of 60 days (1-90). Serial transverse enteroplasty was the most frequent procedure used lengthening the bowel from 40 cm (29-62.5) to 63 cm (49-85), 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 after review of qualified intestinal failure center.

A new surgical technique for short bowel syndrome

ObjectiveShort bowel syndrome (SBS) is a severe intestinal disease that causes malabsorption. Long-term parental nutrition therapy induces infection and liver failure. For the surgical management of intestinal rehabilitation, the intestinal loop lengthening method and serial transverse enteroplasty (STEP) method have been reported, although their effects have proven limited. We herein report a new surgical technique, Saeki–Spiral–Shark (3S) method for SBS using biomimetics of shark intestine.MethodsIn the 3S method, a spiral valve is formed inside the intestine by external sutures. Using a 25 cm length intestinal organ model, we performed both the 3S method and STEP procedure. We then compared the length and fluid passage times of the subsequently formed intestine.ResultsAfter the 3S method was performed, the length of the intestinal model changed to 22 cm, and after the STEP procedure, that was elongated to 30 cm. Although the water passage times did not change markedly, the semi-digestive nutritional supplement passage time slowed down in the model with the 3S method. There was slight leakage in the STEP procedure model.ConclusionsThe 3S method is a unique method of treating SBS based on biomimetics. This procedure does not require an incision of the intestine, which thereby enabling clean and less-invasive surgery. We plan to conduct animal experiments in the future.

213.7: A Data-driven Predictive Analytics Framework for the Analysis of Prognostic Factors and Health Outcomes in Paediatric Intestinal Failure Patients

Introduction: Machine learning (ML) involves computational methods and learning mechanisms that can help generate new knowledge from large databases. These techniques are uniquely suited to analyses of paediatric intestinal failure (IF) where classification, prognostication, identification of risk factors, and knowledge extraction can be challenging. Heterogeneous patient populations, small sample sizes, and variations in treatments may complicate our ability to manually identify trends in data. Factors that predict enteral autonomy (EA) and patient management (optimal intravenous lipid emulsion [ILE] solutions; central venous catheter [CVC] complications) have been described, yet a systematic approach that may be prospectively applied to large datasets has never been performed in this patient population. Our study aims to identify predictors of EA through machine learning (ML) and assess their impact on TPN duration. For patients on TPN, assessments of lipid emulsion (ILE) and central venous catheter (CVC) type were also performed. Methods: Demographics, procedures, and outcomes for patients (N=17) from McMaster Children’s Hospital’s (MCH) Intestinal Rehabilitation Program (1999-2021) were collected for a retrospective chart review. Predictors of EA status were obtained using a decision tree ML model. Performance was evaluated as area under the receiver operator characteristics (AUC) and precision-recall (PR) curves. These predictors were assessed for ability to impact TPN duration with Kaplan-Meier (KM) estimates and Cox proportional-hazards (CPH) models. ILE treatments were compared using the Mann-Whitney U test, and CVC types were compared with KM, CPH, and analysis of variance (ANOVA). Results: The model retrieved 10 predictors of EA status. AUC and PR curves were 91% and 71% respectively. Of these 10 predictors: sex, serial transverse enteroplasty (STEP) procedure, ileocecal valve (ICV) presence, and remnant small bowel length were significant for predicting EA status under KM, but not CPH. For ILE treatment, patients on SMOF Lipid® had lower total bilirubin values compared to Intralipid® at six months (4.0 versus 10.0 uMol/L). Longevity of peripherally inserted central catheters (PICC) was 847 days versus 268 days for tunnelled CVCs, and 181 days for ports (95% CI: 0-2044, 93-443, 144-218). Types of complications were not significantly different across CVC. Conclusions: Our study supports the role for ML frameworks in advanced pattern recognition, and promoting adaptive clinical management. Validation of this model using our single-centre dataset supports similar conclusions derived from larger, multi-center registries. Ongoing use of our ML framework offers a novel contribution to intestinal failure analyses by helping identify unique risk factors and protective factors for EA, and approaches to clinical management in the paediatric IF population.

P7.02: Parenteral Nutrition Free Survival in Pediatric Patients With Short Bowel Syndrome: Transplantation vs. Serial Transverse Enteroplasty (STEP), a Paired Matched Case-Control Study

P7.02: Parenteral Nutrition Free Survival in Pediatric Patients With Short Bowel Syndrome: Transplantation vs. Serial Transverse Enteroplasty (STEP), a Paired Matched Case-Control Study

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

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.

Serial transverse enteroplasty (STEP) in case of short bowel syndrome: did we achieve our goal? A systematic review.

Surveys on Serial Transverse Enteroplasty (STEP) published in international literature (1 January 2003- 31 May 2021) were searched. Articles were included from 17 countries: 1/23 comparative and 22/23 cohort studies. STEP was performed on 308 patients: pediatrics, adults, and mixed ages. Pediatric group included 16 studies and the adult 6. Pre-STEP residual small bowell (SB) length for pediatrics and adults ranged from 18 to 26cm and from 30 to 70cm, respectively. Post-STEP increased SB length for pediatrics and adults ranged between 42 and 100% and 50% and 176%, respectively. For pediatrics, enteral autonomy was reached in 32.22% of cases, parenteral nutrition (PN) dependence was 36.11%, a repeated STEP procedure (Re-STEP) was needed in 17.22%, and a bowel transplant was performed in 6.11%. In adults, enteral autonomy was achieved in 52.38%, while PN dependence was 37.1%, and no Re-STEP or transplantation were required. For the mixed group, post-STEP bowel length increased from 2 to 50cm, enteral autonomy was obtained in 43%, PN dependence was 57%, without reported Re-STEP or transplantation. Mortality rates were between 5.55% (pediatric) and 7.14% (adults). Preoperative length with preservation of ileocecal valve represented the main predictive factors to achieve enteral autonomy.

Organizational and clinical potential of the Federal Register of children with short bowel syndrome

BACKGROUND: Short bowel syndrome is a medical and social problem characterized by high mortality and disability rates, controversial tactics, resource-intensive therapy, and lack of legal support. In 2016, the Russian Association of Pediatric Surgeons initiated the creation of the Federal Register of Children with Short Bowel Syndrome.&#x0D; AIM: This study conducts an audit of the Register to identify the prevalence of the pathological syndrome, establish the causes of its formation and trends in transforming the therapeutic paradigm, determine the pattern, nature, and frequency of various complications, establish factors limiting its informativeness involving representatives of implementors and users, and justify changes increasing database organization and clinical significance.&#x0D; MATERIALS AND METHODS: The Register has 334 patients registered. Of these, 23 children died, and five were removed from the Register at 18. The Quinta software package was used to collect, process, and manage geographically distributed data with information about patients data, identification of medical organizations, diagnosis, the content of therapeutic measures, and the structure of complications.&#x0D; RESULTS: The Register contains data on patients from 71 regions of Russia. Bowel resections prevailed among the initial interventions due to necrotizing enterocolitis (18.0%) and intestinal atresia (17.4%). Reconstructive interventions (125), including serial transverse enteroplasty and spiral intestinal lengthening and tailoring techniques, were implemented in 37 and 24 cases. One hundred and eighty patients needed parenteral nutrition: 18 patients required total parenteral nutrition, and 162 patients needed partial parenteral nutrition. Enteral feeding was used in 193 cases, meeting the needs of 31 children and supplementing parenteral therapy for 162 children. The structural flaw of the Register is the absence of a section on palliative care.&#x0D; CONCLUSIONS: The identified limitations of the Register indicate the need to improve the provided primary information, form a platform for supporting medical decisions, create a palliative care unit, and integrate with state health development programs.

Autologous Intestinal Reconstruction Surgery in Short Bowel Syndrome: Which, When, and Why.

Short bowel syndrome (SBS), secondary to any natural loss or after any extensive bowel resection for congenital malformations or acquired disease, is the most common cause of intestinal failure in children. Extensive introduction of parenteral nutrition (PN) has dramatically changed the outcome of these patients, allowing for long-term survival. The main goal in children with SBS remains to be increasing enteral tolerance and weaning from PN support. Post resection intestinal adaptation allows for achievement of enteral autonomy in a subset of these patients, but the inability to progress in enteral tolerance exposes others to long-term complications of PN. Autologous intestinal reconstruction surgery (AIRS) can facilitate the fulfilment of enteral autonomy, maximizing the absorptive potential of the remaining gut. All the different intestinal reconstruction techniques, from simple procedures like tapering, reversed segments, and colon interposition, to more complex lengthening procedures (LILT: longitudinal intestinal lengthening and tailoring, STEP: serial transverse enteroplasty, and SILT: spiral intestinal lengthening and tailoring) and techniques designed for peculiar problems like controlled intestinal tissue expansion or duodenal lengthening are presented. AIRS indications, clinical applications, and results reported in the literature are reviewed.

Comparing bowel lengthening procedures: which, when, and why?

Purpose of reviewIntestinal failure secondary to short bowel syndrome is still a very serious condition. Treatment consists of parenteral nutrition to provide nutrients and maintain body weight. During the last decades, intestinal lengthening procedures have become more available. The goal of this review is to discuss the results of the literature on the most commonly performed intestinal lengthening procedures.Recent findingsLongitudinal Intestinal Lengthening, Serial Transverse Enteroplasty (STEP), and Spiral Intestinal Lengthening and Tailoring (SILT) are currently the most frequently reported intestinal lengthening procedures. The most recent literature of these procedures is described with respect to indication, technical details, complications, short and long-term outcome, and PN independence.SummaryOn the basis of indication, surgical complexity, complications, and clinical success, we conclude that the STEP procedure is probably the best choice for most centers.

Early Bowel Lengthening Procedures: Bi-Institutional Experience and Review of the Literature.

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.

Serial transverse enteroplasty and nipple valve construction, two life saving techniques for patients with short bowel syndrome, a report of 5 cases

BackgroundVarious abdominal pathologies end up with surgical resection of small intestine. When the small intestine remnant is too short for adequate fluid and micronutrients absorption, short bowel syndrome is diagnosed. The disabling condition needs a multidisciplinary approach to design parenteral nutrition, care for thrombotic, hepatic and infectious complications and gradually wean the patient from parenteral nutrition. Various surgical techniques have been introduced to increase absorptive mucosa and enhance the intestinal adaptation process. Serial transverse enteroplasty and nipple valve reconstruction are among the procedures, which will be discussed in the current article.Case presentationHerein, we presented 5 cases of short bowel syndrome as a consequence of abdominal laparotomies, patients were referred to our center to receive parenteral nutrition and to be prepared for the final autologous gastrointestinal reconstruction or intestinal transplantation, if indicated.ConclusionPatient’s age, performance status and bowel remnant length determines the appropriate technique for autologous gastrointestinal reconstruction. Serial transverse enteroplasty is designed to increase bowel’s length by creating zigzag patterns through dilated bowel loops. Presence of ileocecal valve is crucial to delay intestinal transit time and to prevent colonic bacterial transfer to ileum. Patient’s with ileocecal valve loss benefit from creating an artificial valve, namely, nipple valve.

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect.

The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. In this study, 16 children with SBS underwent MSTEP (2005-2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). With a median follow-up of 5.8 years (0.7-13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

Experiences with intestinal failure from an intestinal rehabilitation unit in a country without home parenteral nutrition.

For the first time, we reported experiences with an intestinal rehabilitation unit (IRU) from a country without home parenteral nutrition (HPN). We included patients with a diagnosis of intestinal failure (IF) since the establishment of our IRU from February 2018 to February 2020. We further report on our protocols for management of enterocutaneous fistulas (ECFs), short-bowel syndrome (SBS), chronic intestinal pseudo-obstruction and motility disorders. Among a total of 349 patients who have been admitted, 100 patients had IF and were included . Mean (SD) age of patients was 46.3 ± 16.1 years. Most common cause of IF was ECFs (32%), SBS (24%), and SBS + fistula (22%). Most common causes of SBS were mesenteric ischemia (63.3%) and repeated surgery (22.4%). Median (interquartile range [IQR]) duration of parenteral nutrition (PN) for patients was 32 (18-60) days. The most common reconstructive surgery performed was resection and anastomosis (75.4%), followed by serial transverse enteroplasty procedure (10.5%) and closure of ostoma (7%). Patients were hospitalized for a median (IQR) of 33 (17.5-61) days. Most common complications were sepsis (45%), catheter infections (43%), and catheter thrombosis (20%), respectively. At the final follow-up, 61% stopped receiving PN, 23% became candidates for transplantation, and 16% died. Considering that most countries lack facilities for HPN, by establishing IRUs using specific treatment protocols and autologous gastrointestinal reconstruction techniques will provide a means to manage patients with IF, thus decreasing death rates and number of patients who require intestinal transplantations due to IF.

A Comprehensive Review of Intestinal Atresias

A Comprehensive Review of Intestinal Atresias

O-16: The Primary and Adjunctive Benefit of Serial Transverse Enteroplasty on Short Gut Patients with Gut Failure

O-16: The Primary and Adjunctive Benefit of Serial Transverse Enteroplasty on Short Gut Patients with Gut Failure