Short Bowel Syndrome: Surgical Therapy

Many surgical solutions to short bowel syndrome have been proposed; however, none has proven to be uniformly successful. Some of these solutions, combined with optimal medical management, may represent the patient's only hope for survival without parenteral nutrition. Most forms of surgical therapy are supportive and aim at controlling three basic pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area. Conservative resection and, thus, prevention of short bowel syndrome remains the best form of treatment at present. In the future, small bowel transplantation may prove to be an important advance in therapy; however, this remains largely experimental due to continued problems with rejection.

Download Full-text

Intraperitoneal fetal small bowel transplantation as therapy for the short bowel syndrome: An animal experimental study

Journal of Pediatric Surgery ◽

10.1016/0022-3468(92)90236-z ◽

1992 ◽

Vol 27 (11) ◽

pp. 1478

Author(s):

Thomas A. Angerpointner

Keyword(s):

Experimental Study ◽

Small Bowel ◽

Short Bowel Syndrome ◽

Small Bowel Transplantation ◽

Short Bowel ◽

Animal Experimental Study

Download Full-text

Anesthetic Management of Small Bowel Transplantation for Short Bowel Syndrome: A case report

Korean Journal of Anesthesiology ◽

10.4097/kjae.2005.48.3.332 ◽

2005 ◽

Vol 48 (3) ◽

pp. 332 ◽

Cited By ~ 1

Author(s):

Jaemin Lee ◽

Chul Soo Park ◽

Hae Wone Chang ◽

Seung Hee Kang ◽

Jong Ho Choi

Keyword(s):

Case Report ◽

Small Bowel ◽

Short Bowel Syndrome ◽

Anesthetic Management ◽

Small Bowel Transplantation ◽

Short Bowel

Download Full-text

The Use of Multiple Serial Transverse Enteroplasty (STEP) Procedures for the Management of Intestinal Atresia and Short Bowel Syndrome

The American Surgeon ◽

10.1177/000313481307900827 ◽

2013 ◽

Vol 79 (8) ◽

pp. 826-828 ◽

Cited By ~ 3

Author(s):

Varun K. Bhalla ◽

Walter L. Pipkin ◽

Robyn M. Hatley ◽

Charles G. Howell

Keyword(s):

Small Bowel ◽

Short Bowel Syndrome ◽

Intestinal Transit Time ◽

Small Bowel Length ◽

Short Bowel ◽

Jejunal Atresia ◽

Repeat Procedure ◽

Step Procedure ◽

Primary Procedure ◽

Serial Transverse Enteroplasty

The serial transverse enteroplasty procedure (STEP) was introduced as a bowel-lengthening procedure to reduce complications related to short bowel syndrome (SBS). Although some have described it as a useful adjunct to the Bianci procedure, others have acknowledged it as a primary procedure. We present a case of jejunal atresia in which two STEP procedures were performed 7 months apart to increase small bowel length. A 1-day-old, term girl presented with a known bowel obstruction diagnosed in utero. A laparotomy revealed a Type IIIb jejunal atresia with no remaining small bowel or cecum. A STEP procedure with an end jejunostomy and ascending colon mucous fistula lengthened the small bowel from 35 to 50 cm. A repeat procedure 7 months later lengthened it to 89 cm. The STEP procedure results in slower intestinal transit time and increases enterocytes contact with oral intake. We performed it during our initial exploration to increase small bowel size by 30 per cent. A repeat procedure 7 months later increased length to 89 cm. The use of multiple, staged STEP procedures avoided the need for bowel transplantation and long-term total parenteral nutrition dependence, demonstrating its effectiveness as a primary procedure for the surgical management of SBS.

Download Full-text

Short bowel syndrome and small bowel transplantation

Current Opinion in Gastroenterology ◽

10.1097/mog.0000000000000035 ◽

2014 ◽

Vol 30 (2) ◽

pp. 128-133 ◽

Cited By ~ 5

Author(s):

John K. DiBaise

Keyword(s):

Small Bowel ◽

Short Bowel Syndrome ◽

Small Bowel Transplantation ◽

Short Bowel

Download Full-text

Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

Canadian Journal of Gastroenterology ◽

10.1155/1990/701014 ◽

1990 ◽

Vol 4 (2) ◽

pp. 70-78

Author(s):

WD Buie ◽

OG Thurston ◽

Richard N Fedorak

Keyword(s):

Surface Area ◽

Short Bowel Syndrome ◽

Intestinal Adaptation ◽

Ileocecal Valve ◽

Significant Loss ◽

Intestinal Transit Time ◽

Short Bowel ◽

Early Use ◽

Adaptive Ability ◽

Mucosal Surface Area

Short bowel syndrome is a clinical entity, a consequence of significant loss of intestinal surface area, and manifests a variable picture of diarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortality rates have been reduced by the early use of parenteral nutrition and have subsequently resulted in increased survival and prevalence of the condition. Ultimate patient survival is dependent on the intrinsic adaptive ability of residual intestine and this, in turn, is dependent upon length, type, functional state and the presence or absence of an ileocecal valve. The mechanisms of intestinal adaptation are not entirely understood; however, they can be grouped into three broad categories: luminal nutrition, hormonal factors, and pancreaticobiliary secretion. Medical treatment of short bowel syndrome remains supportive and centres around the control of three pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area.

Download Full-text