How An Individualised Approach Could Change The Short Bowel Syndrome Fate. Experience From Paediatric Autologous Bowel Reconstruction And Rehabilitation Unit

Background and aims Multidisciplinary treatment of short bowel syndrome (SBS) can be considered to be one of the success stories of paediatric surgery. The authors present their experience during the last decade as a specialist unit using improved techniques and individualised approaches in the management of this condition. Methods Based on data from intestinal rehabilitation program started in 2000, children presenting with SBS were identified. Diagnosis, length of residual bowel, age at definitive surgery, length of bowel pre and post lengthening, and survival were recorded. Data are presented as mean ± SD. Results Fifty-three children were identified (27 boys, 26 girls). Overall survival was 94%. Forty-five children required bowel lengthening and 8 children had simple bowel reconstruction while on our protocol. 7 patients was referred after lengthening complication and after our treatment managed postoperatively in other centres outside the UK. Age at definitive surgery was 10.74 ± 7.9 months. Residual bowel length in patients’ primary treated in our unit was 32.48 ± 25.89 cm. After bowel lengthening, the bowel length was 69.91 ± 42.30 cm (p = 0,0001). Excluding the 3 patients who died, from 50 patients, 25 (50%) are now off TPN and 25 are weaning HPN (Home Parenteral Nutrition) regimen with a 3.87 ± 2.10 nights off. Conclusions Our series shows improved results not only with survival but also in the number of patients that are off TPN. Individualised approach consisting of both medical and surgical expertise is necessary in the management of these patients. The authors advocate centralisation of short bowel services to experienced centres with multidisciplinary expertise.