Overview of non-transplant surgical management of Short Bowel Syndrome in children

Abstract

The aim of this study was to review the management of Short Bowel Syndrome, focusing on the current trends regarding non-transplant, autologous surgical reconstructive techniques. Management of severe Short Bowel Syndrome is still one of the greatest challenges of medicine. Paediatricians and paediatric surgeons may face this challenge often because of the relatively common occurrence of necrotizing enterocolitis, intestinal malrotation, volvulus, gastroschisis and “apple peel” atresia. Although the short term results of intestinal transplantation are improving, the long term results are still disappointing. On the other hand an increasing number of patients have been saved through modern intestinal bowel rehabilitation programs and autologous intestinal reconstructive surgeries in the last decade. This review summarizes the main medical elements of these programs, such as the control of gastric hypersecretion, inhibition of intestinal motility, elemental enteral feeding, low fat (home) parenteral nutrition and hormonal enhancement of intestinal adaptation. It focuses on nontransplant surgical management of short bowel patients, such as accurate vascular access surgery, controlled bowel expansion program, extracorporeal stool recycling and intestinal lengthening techniques.

Conclusion – Intestinal bowel rehabilitation and autologous intestinal reconstruction should be considered as first line management in short bowel patients. The establishment of national bowel rehabilitation centres should be considered. Intestinal transplantation should be reserved for unsuccessful cases and considered as a last resort.