Eur J Pediatr Surg
DOI: 10.1055/s-0041-1735163
Original Article

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

Javier Bueno
1  Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
2  Department of Pediatric Surgery, Mother and Child University Hospital of Badajoz, Extremadura, Spain
,
1  Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
,
Susana Redecillas
1  Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
,
Oscar Segarra
1  Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
,
Manuel López
1  Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
› Author Affiliations

Abstract

Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described.

Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5).

Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines.

Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.



Publication History

Received: 17 February 2021

Accepted: 13 July 2021

Publication Date:
17 September 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany