Institutional Experience with Spiral Intestinal Lengthening and Tailoring

Abstract

Aim The aim of this study was to report our initial experience using spiral intestinal lengthening and tailoring (SILT) technique in selected cases of short bowel syndrome (SBS).

Materials and Methods We analyzed all cases of SBS underwent SILT in our unit since the introduction of the procedure in 2012. We retrospectively analyzed patients' demographics, pre- and postprocedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements. Data were compared using independent samples, Mann–Whitney's U-test.

Results Five children with SBS underwent SILT between 2012 and 2017. Median age at procedure was 8.3 months (4.5–16). Preoperative small bowel length measured a median of 22 cm (17.5–50) with a median diameter of 4 cm (3.5–4.6). SILT allowed a median increase in length of 56% (10–15 cm; p = 0.03) and tailoring of the dilated segment providing a reduction in diameter of 50% (4.3–2.1 cm; p = 0.01). No major complications related to SILT were encountered and none of the children required further surgical intervention following a median follow-up of 26 months (14.5–41). Interestingly, we observed a significant reduction of PN requirement at 6 months (p = 0.008) associated with liver function preservation during the follow-up period.

Conclusion In our experience, SILT is a promising adjunct in the surgical management of SBS. It can be used to tailor and lengthen mildly dilated segments of the bowel where other procedures are technically challenging, with a view to reduce the risk of intestinal failure associated liver disease and thereby improving chances for quality survival. Further studies are needed to investigate long-term outcomes of SILT in pediatric SBS.

Keywords

short bowel syndrome - intestinal lengthening - reconstructive surgery

• References

• 1 Quirós-Tejeira RE, Ament ME, Reyen L. , et al. Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience. J Pediatr 2004; 145 (02) 157-163
• 2 Iyer KR. Surgical management of short bowel syndrome. J Parenter Enteral Nutr 2014; 38 (1, Suppl): 53S-59S
• 3 King B, Carlson G, Khalil BA, Morabito A. Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures. World J Surg 2013; 37 (03) 694-704
• 4 Thompson JS, Rochling FA, Weseman RA, Mercer DF. Current management of short bowel syndrome. Curr Probl Surg 2012; 49 (02) 52-115
• 5 Pakarinen MP. Autologous intestinal reconstruction surgery as part of comprehensive management of intestinal failure. Pediatr Surg Int 2015; 31 (05) 453-464
• 6 Bianchi A. Intestinal loop lengthening--a technique for increasing small intestinal length. J Pediatr Surg 1980; 15 (02) 145-151
• 7 Kim HB, Fauza D, Garza J, Oh JT, Nurko S, Jaksic T. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg 2003; 38 (03) 425-429
• 8 Cserni T, Varga G, Erces D. , et al. Spiral intestinal lengthening and tailoring - first in vivo study. J Pediatr Surg 2013; 48 (09) 1907-1913
• 9 Cserni T, Takayasu H, Muzsnay Z. , et al. New idea of intestinal lengthening and tailoring. Pediatr Surg Int 2011; 27 (09) 1009-1013
• 10 Khalil BA, Ba'ath ME, Aziz A. , et al. Intestinal rehabilitation and bowel reconstructive surgery: improved outcomes in children with short bowel syndrome. J Pediatr Gastroenterol Nutr 2012; 54 (04) 505-509
• 11 Murphy F, Khalil BA, Gozzini S, King B, Bianchi A, Morabito A. Controlled tissue expansion in the initial management of the short bowel state. World J Surg 2011; 35 (05) 1142-1145
• 12 Ba'ath ME, Almond S, King B, Bianchi A, Khalil BA, Morabito A. Short bowel syndrome: a practical pathway leading to successful enteral autonomy. World J Surg 2012; 36 (05) 1044-1048
• 13 Cserni T, Biszku B, Guthy I. , et al. The first clinical application of the spiral intestinal lengthening and tailoring (silt) in extreme short bowel syndrome. J Gastrointest Surg 2014; 18 (10) 1852-1857
• 14 Merras-Salmio L, Pakarinen MP. Refined multidisciplinary protocol-based approach to short bowel syndrome improves outcomes. J Pediatr Gastroenterol Nutr 2015; 61 (01) 24-29
• 15 Dore M, Junco PT, Moreno AA. , et al. Ultrashort bowel syndrome outcome in children treated in a multidisciplinary intestinal rehabilitation unit. Eur J Pediatr Surg 2017; 27 (01) 116-120
• 16 Coletta R, Khalil BA, Morabito A. Short bowel syndrome in children: surgical and medical perspectives. Semin Pediatr Surg 2014; 23 (05) 291-297
• 17 Figueroa-Colon R, Harris PR, Birdsong E, Franklin FA, Georgeson KE. Impact of intestinal lengthening on the nutritional outcome for children with short bowel syndrome. J Pediatr Surg 1996; 31 (07) 912-916
• 18 Pakarinen MP, Pakkasjärvi N, Merras-Salmio L, Koivusalo A, Rintala R. Intestinal rehabilitation of infantile onset very short bowel syndrome. J Pediatr Surg 2015; 50 (02) 289-292
• 19 Bianchi A. Intestinal lengthening: an experimental and clinical review. J R Soc Med 1984; 77 (Suppl. 03) 35-41
• 20 Bianchi A. Experience with longitudinal intestinal lengthening and tailoring. Eur J Pediatr Surg 1999; 9 (04) 256-259
• 21 Bianchi A. From the cradle to enteral autonomy: the role of autologous gastrointestinal reconstruction. Gastroenterology 2006; 130 (02) (Suppl. 01) S138-S146
• 22 Kim HB, Lee PW, Garza J, Duggan C, Fauza D, Jaksic T. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 2003; 38 (06) 881-885
• 23 Alberti D, Boroni G, Giannotti G. , et al. “Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel. Pediatr Surg Int 2014; 30 (11) 1169-1172