Short bowel syndrome surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Surgery is not the first-line treatment option for patients with short bowel syndrome. Surgery is usually reserved for patients with the goal to wean them off from parenteral nutrition. Patients who have severe or worsening malabsorption might require surgery including intestinal transplant. Transplant is contraindicated in patients with active infection or malignancies. Approximately half of the patients with short bowel syndrome will require surgery. Bianchi procedure and serial transverse enteroplasty (STEP) are performed to lengthen dilated bowel. Stricturoplasty might be necessary. Intestinal transplant is reserved for patients who have life-threatening complications of intestinal failure, irreversible permanent total parenteral nutrition requirement and episodes of sepsis or loss of venous access.
Indications
- Surgery is not the first-line treatment option for patients with short bowel syndrome.[1][2][3][4][5]
- The primary goal of surgery is to restore absorption capacity of the small bowel.[6]
- Surgery is usually reserved for patients with either:[7][8][9]
- Restore intestinal continuity
- Severe or worsened malabsorption
- Unsuccessful weaning off parenteral nutrition
- Bowel obstruction
- Recurrent complications
- Transplant is not the first-line surgical option for patients with short bowel syndrome. Transplant is usually reserved for patients with either:[7][10]
- Life-threatening complications of intestinal failure
- Irreversible permanent total parenteral nutrition requirement and episodes of sepsis
- Irreversible permanent total parenteral nutrition requirement and loss of venous access
Contraindications
Transplant is contraindicated in patients with either:[7][11]
Absolute contraindications:
- Active infection
- Malignancies
Relative contraindications:
- Reduced neurodevelopment
- Psychosocial factors
Surgery
- Approximately half of the patients with short bowel syndrome will require surgery. However, there is controversy over the efficacy of these procedures.[12][11][13][14]
- These procedures are usually performed by pediatric surgeons at a quaternary hospital specializing in small bowel surgery.[15]
- There are two categories of surgery for short bowel syndrome including non-transplant and transplant interventions.[10]
Non-transplant
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Transplant
- Isolated intestinal transplant
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- Combined intestinal and liver transplant
References
- ↑ Wilmore, Douglas W.; Robinson, Malcolm K. (2014). "Short Bowel Syndrome". World Journal of Surgery. 24 (12): 1486–1492. doi:10.1007/s002680010266. ISSN 0364-2313.
- ↑ Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. doi:10.1016/j.jand.2013.05.001. ISSN 2212-2672.
- ↑ Tappenden KA (2014). "Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy". JPEN J Parenter Enteral Nutr. 38 (1 Suppl): 14S–22S. doi:10.1177/0148607113520005. PMID 24500909.
- ↑ DiBaise JK, Young RJ, Vanderhoof JA (2004). "Intestinal rehabilitation and the short bowel syndrome: part 1". Am. J. Gastroenterol. 99 (7): 1386–95. doi:10.1111/j.1572-0241.2004.30345.x. PMID 15233682.
- ↑ DiBaise JK, Young RJ, Vanderhoof JA (2004). "Intestinal rehabilitation and the short bowel syndrome: part 2". Am. J. Gastroenterol. 99 (9): 1823–32. doi:10.1111/j.1572-0241.2004.40836.x. PMID 15330926.
- ↑ Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
- ↑ 7.0 7.1 7.2 Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. doi:10.1016/j.suc.2011.02.006. ISSN 0039-6109.
- ↑ 8.0 8.1 Botey, Mireia; Alastrué, Antonio; Haetta, Henrik; Fernández-Llamazares, Jaume; Clavell, Arantxa; Moreno, Pau (2017). "Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases". Case Reports in Gastroenterology. 11 (1): 229–240. doi:10.1159/000452734. ISSN 1662-0631.
- ↑ Kelly DG, Tappenden KA, Winkler MF (2014). "Short bowel syndrome: highlights of patient management, quality of life, and survival". JPEN J Parenter Enteral Nutr. 38 (4): 427–37. doi:10.1177/0148607113512678. PMID 24247092.
- ↑ 10.0 10.1 Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. doi:10.4103/1319-3767.82573. ISSN 1319-3767.
- ↑ 11.0 11.1 Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
- ↑ Limketkai BN, Parian AM, Shah ND, Colombel JF (2016). "Short Bowel Syndrome and Intestinal Failure in Crohn's Disease". Inflamm. Bowel Dis. 22 (5): 1209–18. doi:10.1097/MIB.0000000000000698. PMID 26818425.
- ↑ Keller J, Panter H, Layer P (2004). "Management of the short bowel syndrome after extensive small bowel resection". Best Pract Res Clin Gastroenterol. 18 (5): 977–92. doi:10.1016/j.bpg.2004.05.002. PMID 15494290.
- ↑ Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. doi:10.1177/0115426505020005493. PMID 16207689.
- ↑ Martin LY, Ladd MR, Werts A, Sodhi CP, March JC, Hackam DJ (2017). "Tissue engineering for the treatment of short bowel syndrome in children". Pediatr. Res. doi:10.1038/pr.2017.234. PMID 28937976.