Colonic interposition in children with short bowel syndrome

Introduction: Surgical management of short bowel syndrome (SBS) remains challenging. Colonic intestinal interposition (CII) is a surgical alternative to slow transit time in patients with SBS associated with severe diarrhea. We report our experience using colonic interposition in a cohort of SBS infants. Methods: We analysed retrospectively all patients with SBS that underwent CII at our unit between 2011 and 2016. Results: Thirteen patients with SBS underwent CII (n=13). Underline diagnosis were volvulus (n=10), intestinal atresia (n=2) and necrotising enterocolitis (NEC) (n=1). Preoperative mean bowel length after surgery was 13.80±3.60 cm and daily bowel outputs were 8.5±2.92 stools. CII was performed as primary procedure in 6 patients and combined to a lengthening procedure in 7 patients [4 serial transverse enteroplasty (STEP) with CII; 2 Longitudinal Intestinal Lengthening and Tailoring (LILT) with CII; and 1 Duodenal Antemesenteric Serial Tapering (DAST) with CII]. At a mean follow-up of 17 months daily bowel outputs were reduced (p=0,0078). Home parenteral nutrition was weaned in all patients (mean 4±2 nights) and the mean weight gain was 4.1±2.1 kg. One patient developed an enterocutaneous fistula that required resection of the CII segment. Conclusion: CII is a good surgical alternative for SBS patients that are otherwise not eligible for conventional bowel lengthening procedures because of insufficient remnant bowel but will benefit of transit time reduction. CII can be performed either as an isolated or as combined procedure. CII seems to be a safe autologous gastrointestinal intervention with a reduction of stool frequency and improvement of nutrient absorption without sacrificing the remaining bowel.