Abstract
Intestinal failure (IF) requires a multidisciplinary management based on nutritional
support, surgical and medical rehabilitation, and transplantation. The aim of this
study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty,
Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel
syndrome (SBS) and poor prognosis due to complex abdominal pathology.
We performed a single-center retrospective study of patients with IF evaluated for
intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an
SRT. Nonparametric tests were used for statistical analysis.
A total of 205 patients (107 males/98 females) with mean age of 25 ± 7 months were
assessed for IF. A total of 433 laparotomies were performed on 130 patients including
intestinal resection, enteroplasties, adhesiolysis, and transit reconstruction. SRT
were performed in 22 patients: 12 enteroplasties, 8 STEPs, and 4 Bianchi procedures.
All patients were parenteral nutrition (PN) dependent with different stages of liver
disease: mild (13), moderate (5), and severe (4). The adaptation rate for patients
who underwent enteroplasty, STEP, and Bianchi were 70, 63, and 25%, respectively,
although the techniques are not comparable. Overall, intestinal adaptation was achieved
in nine (41%) patients, and four (18%) patients showed significant reduction of PN
needs. One child did not respond to SRT and did not meet transplantation criteria.
The remaining eight (36%) patients were included on the waiting list for transplant:
four were transplanted, two are still on the waiting list, and two died. Better outcomes
were observed in milder cases of liver disease (mild 77%, moderate 40%, severe 25%)
(p < 0.05). Conversely, a trend toward a poorer outcome was observed in cases with ultrashort
bowel (p > 0.05). One patient required reoperation after a Bianchi procedure due to intestinal
ischemia and six needed further re-STEP or adhesiolysis procedure several months later.
The median follow-up was 62 (3–135) months. Overall mortality was 19%, and was due
to end-stage liver disease and/or central venous catheter–related sepsis. SRT led
to intestinal adaptation in a significant number of patients with poor prognosis SBS
referred for intestinal transplantation. However, SRT requires a multidisciplinary
evaluation and should be attempted only in suitable cases. Careful assessment and
optimal surgical timing is crucial to obtain a favorable outcome.
Keywords
surgical rehabilitation techniques - intestinal failure - short bowel syndrome
