American Surgical Association
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Comparison of Intestinal Lengthening Procedures For Patients With Short Bowel Syndrome
Debra Sudan*, Jon Thompson, Steve Raynor*
University of Nebraska Medical Center, Omaha, NE

OBJECTIVE(S): Review the clinical results of 24 years of intestinal lengthening procedures at one institution.
METHODS: Retrospective review of survival, parenteral nutrition (TPN) weaning, durability of improved function and complications in a series of 62 patients with indications for intestinal transplantation, who underwent Bianchi or serial transverse enteroplasty (STEP) lengthening.
RESULTS: Sixty-two patients including 13 adults underwent 40 Bianchi and 31 STEP procedures between 1982 and 2006. Three patients had prior liver transplants. The median (range) remnant bowel length prior to lengthening was 49 (14-120) cm overall; (Bianchi = 44 cm, STEP = 56 cm) and 75 (20 - 149) cm after lengthening; (Bianchi = 68 cm, STEP = 87). Actual survival is 94% overall (Bianchi 93%, STEP 97%) with median follow-up of 3.7 years (Bianchi 5.9 years, STEP 1.7 years). Average enteral caloric intake in pediatric patients was 15 kcal/ kg prior to lengthening and 85 kcal/kg at 1 year following lengthening. Sixty percent of patients are off TPN at most recent follow-up, although 80% were initially weaned from TPN. Liver disease (when present) was reversed in 85%. Surgical complications occurred in 10 %, more commonly after Bianchi than STEP. Intestinal transplantation salvage was required in 10% at a median of 3.1 years (range = 1.2 - 5.6) after lengthening.
CONCLUSIONS: Lengthening results in durable improvement in enteral nutrition, reverses complications of TPN, avoids intestinal transplantation in the majority with few surgical complications. Intestinal transplantation can salvage those patients that later develop life-threatening complications or fail to wean TPN.

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