Spiral intestinal lengthening and tailoring (SILT) as a rescue procedure for SBS patients with difficult clinical situations.

Introduction: Autologous gastrointestinal reconstructive (AGIR) procedures are essential component of intestinal rehabilitation program for patient with short bowel syndrome (SBS). Unfortunately, several patients develop postoperative bowel re-dilatation with loss of bowel adaptation. Spiral intestinal lengthening and tailoring (SILT) technique promises to regain intestinal physiology by tailoring the bowel even if there is no massive bowel dilatation. The aim of this study was to report our experience using SILT in SBS with difficult clinical situation. Methods: Retrospective review of the single AGIR surgeon was performed from 2012 to date. Patients’ demographics, pre- and post-procedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements were analyzed. Data were compared using independent samples, Mann-Whitney’s U-test. Data were expressed in mean (IQR) Results: 9 children with SBS underwent SILT between 2012 and 2017. Rescue SILT was performed in 4 patients with age at procedure of 58.5 months (45–143.3). 3 patients had previous STEP in history of SBS post gastroschisis while one had mild dilatation after AGIR due to long segment Hirschsprung. Preoperative small bowel length measured 66 cm (49.5–75.7) with a diameter of 7 cm (6–8). SILT allowed a median increase in length of 68.5% (p = 0.34) and a significant tailoring of the dilated segment providing a reduction in diameter of 63% (p = 0.02). No major complications related to SILT were encountered and none of the children required further surgical intervention following a follow-up of 6.5 months (4.5–39.6). Interestingly, a significant reduction of PN requirement at 4 months (p = 0.02) associated with improve of liver function was reported. Conclusion: In this study SILT was reported to have no peri-operative complication and to have good results in complex SBS patients. This procedure offers a safe alternative for SBS children after the failure of conventional AGIR procedures.