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Current Concepts of Intestinal Failure pp 105–112Cite as

Current Concepts of Intestinal Failure: Serial Transverse Enteroplasty

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Abstract

Pediatric intestinal failure (IF) is associated with significant morbidity and mortality, the most frequent underlying etiology being short bowel syndrome (SBS). The major goals of treatment include normal growth, prevention of complications, and weaning off parenteral support (PS) by maximal utilization of adaptation potential of the remaining gut. In a subset of SBS patients, the small intestinal remnant undergoes excessive adaptation-associated dilatation. Abnormal postresectional bowel dilatation predisposes to stasis, defective propulsion, and mixing of intestinal contents, which in turn may promote bacterial overgrowth and worsen malabsorption. Normal and uniform bowel diameter can be effectively restored surgically by serial transverse enteroplasty (STEP), while preserving the entire limited intestinal absorptive surface. Elimination of pathological dilatation with simultaneous increase in functional bowel length has potential to decrease parenteral nutrition (PN) dependence by improving enteral feeding tolerance and intestinal absorptive function. Reduced PS requirement limits the extent of complications, improving prognosis and quality of life. Current evidence suggests that STEP is a safe and well-tolerated procedure, which facilitates weaning from PN and promotes growth in selected patients. Redilatation is a common and significant complication, which can be dealt with by repeat STEP in symptomatic cases. Eventually a majority of patients achieve enteral autonomy. STEP may reduce the need for intestinal transplantation.

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Abbreviations

AIR:

Autologous intestinal reconstruction

IF:

Intestinal failure

IFALD:

Intestinal failure-associated liver disease

ITx:

Intestinal transplantation

LILT:

Longitudinal lengthening and tailoring

PN:

Parenteral nutrition

PS:

Parenteral support

SBS:

Short bowel syndrome

STEP:

Serial transverse enteroplasty

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Financial Support

Mikko Pakarinen was supported with research grants by the Finnish Pediatric Research Foundation and the Sigrid Juselius Foundation. Tomas Wester was supported by Her Royal Highness Crown Princess Lovisa’s Foundation.

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Authors and Affiliations

  1. Section of Pediatric Surgery, Pediatric Liver and Gut Research Group Helsinki, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 11, 281, Helsinki, 00029 HUS, Finland

    Mikko P. Pakarinen

  2. Unit of Pediatric Surgery, Karolinska University Hospital and Karolinska Institutet, Q3:03 Solna, Stockholm, SE-171 76, Sweden

    Tomas Wester

Authors
  1. Mikko P. Pakarinen
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  2. Tomas Wester
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Correspondence to Mikko P. Pakarinen .

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Editors and Affiliations

  1. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Risto J. Rintala

  2. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Mikko Pakarinen

  3. Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden

    Tomas Wester

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Pakarinen, M.P., Wester, T. (2016). Current Concepts of Intestinal Failure: Serial Transverse Enteroplasty. In: Rintala, R., Pakarinen, M., Wester, T. (eds) Current Concepts of Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-42551-1_8

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  • DOI: https://doi.org/10.1007/978-3-319-42551-1_8

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