Comment on “European Pediatric Surgeon'Association Survey on the Management of Short-Bowel Syndrome”

We read with interest the article by Dariel et al “European Pediatric Surgeon' Association survey on the management of short-bowel syndrome” recently published in the journal.[1] Based on our pediatric surgical experience previously in Manchester (UK)[2] and ongoing in Florence (Italy)[3] which has been double-checked by an external reviewer/author (A.L.), we would like to provide comments on the article ([Table 1]). Regarding institutional practices, Manchester and Florence are high-volume centers with an Intestinal Rehabilitation Program but no transplant surgeon. As with most of the European centers, we use surgical strategies (>3 We do sometimes alter our primary surgical management, dependent on the underlying disease leading to short bowel syndrome: in keeping with most European centers, in Manchester, we performed a jejunostomy followed by an anastomosis to colonic remnant in the presence of ultra-short bowel due to proximal jejunal atresia. In Florence, we have recently switched our management to a more aggressive approach performing primary anastomosis to the colonic remnant. However, in cases of complete midgut volvulus with extensive necrotic bowel or multiple intestinal atresias, we have always performed a resection instead of a more conservative approach such as the one reported by most of the European Pediatric Surgeons' Association members. We do understand that the main concern of the pediatric surgeon should be the preservation of the small bowel length and function, but our primary concern is to not leave nonviable bowel, worsening the prognosis in such a frail group of patients. We request the author's opinion on our comments: we do appreciate and congratulate them for their innovative surgical effort in such a difficult and challenging field. /year in Manchester and 3 procedures/year in Florence) to facilitate enteral autonomy, promoting intestinal adaptation through an early stoma closure .