Combined Autologous Gastrointestinal Reconstruction Procedures in Children with Short Bowel Syndrome our experience with the first 17 patients

Introduction: Patients with short bowel syndrome (SBS) require careful evaluation and treatment. The aim of the study is to report the Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit (PABRRU) experience with combined autologous gastrointestinal reconstructive (AGIR) procedures in children with SBS. Methods: Retrospective study of patients with SBS treated with combined AGIR procedures between 2008 and 2013. AGIR procedures were defined as combined when more than one technique was used on the same patient. Procedures used were: Longitudinal Intestinal Lengthening and Tailoring (LILT) or Serial Transverse Enteroplasty Procedure (STEP), Spiral Intestinal Lengthening and Tailoring (SILT), Duodenal Antimesenteric Serial Tapering (DAST) and slow transit time procedure. Results: Overall 34 children underwent AGIR procedures for SBS at the PABRRU unit. Almost half of them (n=17) underwent combined lengthening and tailoring procedures at a mean age of 2.6±2.75 years. Mean preoperative small bowel length was 25.8±16.7 cm, this increase after lengthening to 43±22.5 cm (p < 0.0001). Thirteen patients (n=13) underwent synchronous AGIR procedures during one operation: 3 LILT with DAST, 2 LILT with STEP, 2 STEP with SILT, 2 DAST with jejunal interposition, 1 LILT with colonic interposition, 1 DAST with STEP, 1 STEP with jejunal reverse segment, 1 SILT with STEP and Duhamel procedure in a patient with Hirschsprung’s disease. None of these patients required further bowel lengthening procedures. Four patients (n=4) underwent sequential AGIR procedures after a mean time of 11.59±10 months: 1 DAST after LILT, 1 STEP after LILT, 1 colonic interposition after STEP and 1 colonic interposition after LILT. Overall mean follow-up time after surgery was 56 months. Complications reported were bowel obstruction due to anastomotic stricture in 3 patients. All patients were weaned from parenteral nutrition regimen with a 3.1±2 nights off with an increase of weight (1.5±1 kg). There were no intraoperative complications. Conclusion: This is the first report of combined AGIR procedures that are individually tailored to meet patient's needs. The synchronous use of AGIR procedures is a good surgical alternative to maximize bowel lengthen with low complications when performed by an experienced surgeon.