Eur J Pediatr Surg 2021; 31(05): 456-457
DOI: 10.1055/s-0041-1731392
Letter to the Editor

Comment on “European Pediatric Surgeon' Association Survey on the Management of Short-Bowel Syndrome”

Augusto Lauro
1  Department of Surgical Sciences “F. Durante,” Sapienza University, Rome, Italy
,
Riccardo Coletta
2  Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy
,
Antonino Morabito
2  Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy
› Author Affiliations
Funding None.

We read with interest the article by Dariel et al “European Pediatric Surgeon' Association survey on the management of short-bowel syndrome” recently published in the journal.[1] Based on our pediatric surgical experience previously in Manchester (UK)[2] and ongoing in Florence (Italy)[3] which has been double-checked by an external reviewer/author (A.L.), we would like to provide comments on the article ([Table 1]). Regarding institutional practices, Manchester and Florence are high-volume centers with an Intestinal Rehabilitation Program but no transplant surgeon. As with most of the European centers, we use surgical strategies (>3 procedures/year in Manchester and 3 procedures/year in Florence) to facilitate enteral autonomy, promoting intestinal adaptation through an early stoma closure.

Table 1

Comparison of data between European Pediatric Surgeons' Association and Manchester/Florence

European Pediatric Surgeons' Association

Manchester

Florence

65 European centers

(data up to 2019)

101 patients

(1982–2017)

26 patients

(2018–2021)

Institutional practices

Majority of centers

 Number of new pediatric patients with short bowel syndrome treated per year

1–2

>5

>5

 Members of the multidisciplinary Intestinal Rehabilitation Program

No transplant surgeon

No transplant surgeon

No transplant surgeon

 Accredited program for teaching home parenteral nutrition to parents

No

Yes

Yes

Primary surgical management of underlying disease leading to short bowel syndrome

Majority of centers

 Complete midgut volvulus with extensive necrotic bowel

No resection followed by second look

Limited resection

Complete resection

 Multiple intestinal atresia

Preserve all segments

Resect segments to perform 2–3 anastomoses

Resect segments to perform 2–3 anastomoses

 Ultra-short bowel due to proximal jejunal atresia

Jejunostomy followed by anastomosis to colonic remnant

Jejunostomy followed by anastomosis to colonic remnant

Primary anastomosis to colonic remnant

Strategies to facilitate enteral autonomy

Majority of centers

 Frequency of surgical lengthening procedures

2–3/y

>3/y

3/y

 Procedures of choice for small bowel dilatation (complicated with bacterial overgrowth and dysmotility)

Step

Bianchi

Step

 Strategies to promote intestinal adaptation

Early stoma closure

Early stoma closure

Early stoma closure

We do sometimes alter our primary surgical management, dependent on the underlying disease leading to short bowel syndrome: in keeping with most European centers, in Manchester, we performed a jejunostomy followed by an anastomosis to colonic remnant in the presence of ultra-short bowel due to proximal jejunal atresia. In Florence, we have recently switched our management to a more aggressive approach performing primary anastomosis to the colonic remnant.

However, in cases of complete midgut volvulus with extensive necrotic bowel or multiple intestinal atresias, we have always performed a resection instead of a more conservative approach such as the one reported by most of the European Pediatric Surgeons' Association members. We do understand that the main concern of the pediatric surgeon should be the preservation of the small bowel length and function, but our primary concern is to not leave nonviable bowel, worsening the prognosis in such a frail group of patients.

We request the author's opinion on our comments: we do appreciate and congratulate them for their innovative surgical effort in such a difficult and challenging field.



Publication History

Received: 29 March 2021

Accepted: 17 May 2021

Publication Date:
09 July 2021 (online)

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