Long‐Term Outcome in Patients With Short Bowel Syndrome After Longitudinal Intestinal Lengthening and Tailoring

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 47; no. 5; pp. 573 - 578
• Main Authors: Reinshagen, K, Kabs, C, Wirth, H, Hable, N, Brade, J, Zahn, K, Hagl, C, Jester, I, Waag, KL
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01.11.2008; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Body Height; Body Weight; Child; Child, Preschool; Feeding. Feeding behavior; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Infant; Intestinal lengthening; Intestinal Mucosa - physiopathology; Intestinal Mucosa - surgery; Intestine, Small - anatomy & histology; Intestine, Small - pathology; Intestines - surgery; Medical sciences; Other diseases. Semiology; Parenteral Nutrition; Retrospective Studies; Short bowel syndrome; Short Bowel Syndrome - mortality; Short Bowel Syndrome - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgical treatment; Survival Rate; Survivors; Time Factors; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Human; Prognosis; Gut; Metabolic diseases; Short bowel syndrome; Long term; Treatment; Intestinal malabsorption; Surgery; Gastroenterology; Intestinal lengthening-Short bowel syndrome- Surgical treatment; Digestive diseases; Intestinal disease
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0b013e31816232e3

ABSTRACT Objectives: Longitudinal intestinal lengthening and tailoring (LILT) is a well‐established surgical treatment for short bowel syndrome. It has been shown to enhance peristalsis, decrease bacterial overgrowth, and extend mucosal contact time for nutrients. We present the results of a long‐term follow‐up of patients who underwent LILT and define prognostic parameters for the survival of these patients. Patients and Methods: Between 1987 and 2006, 53 patients underwent LILT in our institution. The main diagnoses were gastroschisis, intestinal volvulus, intestinal atresias, and necrotizing enterocolitis. LILT was performed at a mean age of 24 months (range 4−144 months). The follow‐up time was 79.76 months (range 6−234 months). Results: After LILT, 41 of 53 patients survived, and 36 of 41 surviving patients were successfully weaned from parenteral nutrition (PN). In long‐term follow‐up 79% stayed free of PN. The overall survival rate was 77.36%. Weight gain occurred in 58% of the patients after LILT. The quality of life after LILT is on a high level, with most patients having normal physical strength and participating in normal social life and education. Prognostic factors for survival after LILT in short bowel syndrome are length of small intestine (0.06582 + 0.0131 × bowel cm), length of large bowel (P = 0.039), preoperative liver function, and successful weaning from PN within 18 months postoperatively (P = 0.0032). Conclusions: Patients undergoing LILT in short bowel syndrome have a high survival rate, weight gain, and a high quality of life. Autologous gastrointestinal reconstruction remains therefore the first choice in the treatment of patients with short bowel syndrome.