Autologous intestinal lengthening procedures for short bowel syndrome. A systematic review of clinical effectiveness and an assessment of their utility for adult and paediatric patients with intestinal failure in the UK

Introduction:Short bowel syndrome (SBS) results from surgical resection, congenital defector disease-associated loss of absorption and is characterized by the inabilityto maintain protein-energy, fluid, electrolyte or micronutrient balances whenon a conventionally accepted, normal diet 1 . In order to survive, the SBSpatient necessitates parenteral nutrition or an alternative medical or surgicaltreatment to improve intestinal absorptive capacity. The surgical treatmentoptions are autologous gastrointestinal reconstruction, intestinal lengtheningor intestinal transplantation. Longitudinal intestinal lengthening and tailoring(LILT) and serial transverse enteroplasty (STEP) are the main modalities ofintestinal lengthening with successful outcome.Aim:To systematically evaluate the result of this autologous "lengthening"procedures in adults and children and determine their morbidity, mortality andthe frequency with which patients can expect restoration of nutritional andmetabolic autonomy. To evaluate their clinical effectiveness and anassessment of their utility for adults and paediatric patients with intestinalfailure in the UK.Results:330 patients underwent 343 intestinal lengthening procedures between 1980and 2011. Age ranged from 1 day old to 66 years old. The most commoncauses of SBS requiring intestinal lengthening in children were small bowelatresia (27%), gastroschisis (27%), necrotising enterocolitis (16.5%) andmidgut volvulus (16.5%). In adults, the causes were mainly acute mesentericinfarct, surgical resection and mid gut volvulus.Two hundred and thirty one patients (67.3%) underwent LILT and 96 patients(28%) had STEP as primary procedure. Further 13 patients (3.8%) had re-STEP operation and 2 had Kimura procedure.There was an increase in total mean bowel length of 61.9% (29.4 cm); 55.1%in STEP and 67.2% in LILT. Total parenteral nutrition (TPN) was successfullydiscontinued in 53% of patients after between 10 weeks and 5 years of followup.The most common operative complications were bowel obstruction (19.8%),re-dilatation (15.1%) and leaks (8.1%). Catheter related complications(12.8%) were the most common non surgical complication, followed by liverfailure (10.5%). Sixty three deaths (19.1%) were registered mainly due to liverfailure and sepsis (66.6%), of which 9 patients died post-transplant.Fifteen adults underwent lengthening, with a median age of 38 (18-66) yrs.There were 8 LILT and 7 STEP procedures. One death was reported due toliver failure as the patient refused to undergo transplant surgery.Conclusion:Intestinal lengthening appears to be a valuable treatment option for thepaediatric short bowel patient, allowing approximately 50% to regainnutritional independence. The experience in the adult population is muchmore limited. Intestinal lengthening procedures are associated with morbidityin up to 20%. Although 20% of patients died, the majority of deaths were notrelated lengthening surgery but to complications of end stage liver diseaseresulting from short bowel syndrome.

Level dc:type.qualificationlevel

Master's Level (Level 7)

Year dc:date.issued

2026

Author dc:creator

• Heydari Khajehpour, S

Language dc:language

en

Identifier

oai:salford-repository.worktribe.com:1405610

OAI identifier oai:identifier

oai:salford-repository.worktribe.com:1405610