Short bowel syndrome surgery

Short bowel syndrome Microchapters
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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 [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3].

Indications

• Surgery is not the first-line treatment option for patients with short bowel syndrome. Surgery is usually reserved for patients with either:
  • [Indication 1]
  • [Indication 2]
  • [Indication 3]
• Transplant is not the first-line surgical option for patients with short bowel syndrome. Transplant is usually reserved for patients with either:
  • Life-threatening complications of intestinal failure
  • Irreversible permanent total parenteral nutrition (TPN) requirement and episodes of sepsis
  • Irreversible permanent total parenteral nutrition (TPN) requirement and loss of venous access

Contraindications

• Transplant is contraindicated in patients with either:
  • Absolute
    • Active infection
    • Malignancies
  • Relative
    • 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.
• These procedures are usually performed by pediatric surgeons at a quaternary hospital who specialize in small bowel surgery.
• There are two categories of surgery for sort bowel syndrome including non-transplant and transplant interventions.
  • Non-transplant
    • Stricturoplasty 
    • Surgical procedures to lengthen dilated bowel
      • Bianchi procedure: Bowel is cut in half and one end is sewn to the other

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• Serial transverse enteroplasty (STEP): Bowel is cut and stapled in a zigzag pattern

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• Transplant
  • Isolated intestinal transplant
  • Combined intestinal and liver transplant