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Eur J Pediatr Surg 2022; 32(04): 352-356
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
,
Laura García-Martínez 
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
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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.

Keywords

short bowel syndrome - intestinal lengthening - serial transverse enteroplasty


Publication History

Received: 17 February 2021

Accepted: 13 July 2021

Article published online:
17 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kim HB, Lee PW, Garza J, Duggan C, Fauza D, Jaksic T. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 2003; 38 (06) 881-885
    CrossrefPubMedGoogle Scholar
  • 2 Bianchi A. Intestinal loop lengthening–a technique for increasing small intestinal length. J Pediatr Surg 1980; 15 (02) 145-151
    CrossrefPubMedGoogle Scholar
  • 3 Kim HB, Fauza D, Garza J, Oh JT, Nurko S, Jaksic T. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg 2003; 38 (03) 425-429
    CrossrefPubMedGoogle Scholar
  • 4 Bueno J, Redecillas S, GarcÍa L. et al. Duodenal lengthening in short bowel with dilated duodenum. J Pediatr Surg 2015; 50 (03) 493-496
    CrossrefPubMedGoogle Scholar
  • 5 Bueno J, Burgos R, Redecillas S, López M, Balsells J. Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report. Rev Esp Enferm Dig 2018; 110 (01) 59-62
    PubMedGoogle Scholar
  • 6 Frongia G, Kessler M, Weih S, Nickkholgh A, Mehrabi A, Holland-Cunz S. Comparison of LILT and STEP procedures in children with short bowel syndrome – a systematic review of the literature. J Pediatr Surg 2013; 48 (08) 1794-1805
    CrossrefPubMedGoogle Scholar
  • 7 Ramos-Gonzalez G, Kim HB. Autologous intestinal reconstruction surgery. Semin Pediatr Surg 2018; 27 (04) 261-266
    CrossrefPubMedGoogle Scholar
  • 8 King B, Carlson G, Khalil BA, Morabito A. Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures. World J Surg 2013; 37 (03) 694-704
    CrossrefPubMedGoogle Scholar
  • 9 Jones BA, Hull MA, Potanos KM. et al; International STEP Data Registry. Report of 111 consecutive patients enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: a retrospective observational study. J Am Coll Surg 2013; 216 (03) 438-446
    CrossrefPubMedGoogle Scholar
  • 10 Wester T, Lilja HE, Stenström P, Pakarinen M. Absent ileocecal valve predicts the need for repeated step in children. Surgery 2017; 161 (03) 818-822
    CrossrefPubMedGoogle Scholar
  • 11 Barrett M, Demehri FR, Ives GC, Schaedig K, Arnold MA, Teitelbaum DH. Taking a STEP back: assessing the outcomes of multiple STEP procedures. J Pediatr Surg 2017; 52 (01) 69-73
    CrossrefPubMedGoogle Scholar
  • 12 Gibbons TE, Casteel HB, Vaughan JF, Dassinger MS. Staple line ulcers: a cause of chronic GI bleeding following STEP procedure. J Pediatr Surg 2013; 48 (06) E1-E3
    CrossrefPubMedGoogle Scholar
  • 13 Fisher JG, Stamm DA, Modi BP, Duggan C, Jaksic T. Gastrointestinal bleeding as a complication of serial transverse enteroplasty. J Pediatr Surg 2014; 49 (05) 745-749
    CrossrefPubMedGoogle Scholar
  • 14 Oliveira C, de Silva N, Wales PW. Five-year outcomes after serial transverse enteroplasty in children with short bowel syndrome. J Pediatr Surg 2012; 47 (05) 931-937
    CrossrefPubMedGoogle Scholar