Short bowel syndrome surgery: Difference between revisions
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==Indications== | ==Indications== | ||
*[[Surgery]] is not the first-line treatment option for patients with short bowel syndrome. | *[[Surgery]] is not the first-line treatment option for patients with short bowel syndrome. | ||
*The primary goal of [[surgery]] is to restore [[absorption]] capacity of the [[Small intestine|small bowel]]. | *The primary goal of [[surgery]] is to restore [[absorption]] capacity of the [[Small intestine|small bowel]].<ref name="pmid17198059">{{cite journal |vauthors=Misiakos EP, Macheras A, Kapetanakis T, Liakakos T |title=Short bowel syndrome: current medical and surgical trends |journal=J. Clin. Gastroenterol. |volume=41 |issue=1 |pages=5–18 |year=2007 |pmid=17198059 |doi=10.1097/01.mcg.0000212617.74337.e9 |url=}}</ref> | ||
*[[Surgery]] is usually reserved for patients with either:<ref name="ThompsonWeseman2011" /><ref name="BoteyAlastrué2017">{{cite journal|last1=Botey|first1=Mireia|last2=Alastrué|first2=Antonio|last3=Haetta|first3=Henrik|last4=Fernández-Llamazares|first4=Jaume|last5=Clavell|first5=Arantxa|last6=Moreno|first6=Pau|title=Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases|journal=Case Reports in Gastroenterology|volume=11|issue=1|year=2017|pages=229–240|issn=1662-0631|doi=10.1159/000452734}}</ref> | *[[Surgery]] is usually reserved for patients with either:<ref name="ThompsonWeseman2011" /><ref name="BoteyAlastrué2017">{{cite journal|last1=Botey|first1=Mireia|last2=Alastrué|first2=Antonio|last3=Haetta|first3=Henrik|last4=Fernández-Llamazares|first4=Jaume|last5=Clavell|first5=Arantxa|last6=Moreno|first6=Pau|title=Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases|journal=Case Reports in Gastroenterology|volume=11|issue=1|year=2017|pages=229–240|issn=1662-0631|doi=10.1159/000452734}}</ref> | ||
**Restore [[Intestine|intestinal]] continuity | **Restore [[Intestine|intestinal]] continuity | ||
Revision as of 21:10, 8 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Surgery is not the first-line treatment option for patients with short bowel syndrome. Surgery is usually reserved for patients with the goal to wean them off parenteral nutrition. Patients who have severe or worsened malabsorption might require surgery including intestinal transplant.
Indications
- Surgery is not the first-line treatment option for patients with short bowel syndrome.
- The primary goal of surgery is to restore absorption capacity of the small bowel.[1]
- Surgery is usually reserved for patients with either:[2][3]
- Restore intestinal continuity
- Severe or worsened malabsorption
- Unsuccessful weaning off parenteral nutrition
- Bowel obstruction
- Recurrent complications
- Transplant is not the first-line surgical option for patients with short bowel syndrome. Transplant is usually reserved for patients with either:[2][4]
- Life-threatening complications of intestinal failure
- Irreversible permanent total parenteral nutrition requirement and episodes of sepsis
- Irreversible permanent total parenteral nutrition requirement and loss of venous access
Contraindications
- Transplant is contraindicated in patients with either:[5][2]
- Absolute
- Active infection
- Malignancies
- Relative
- Reduced neurodevelopment
- Psychosocial factors
- Absolute
Surgery
- Approximately half of the patients with short bowel syndrome will require surgery. However, there is controversy over the efficacy of these procedures.[6]
- These procedures are usually performed by pediatric surgeons at a quaternary hospital who specialize in small bowel surgery.[4]
- There are two categories of surgery for short bowel syndrome including non-transplant and transplant interventions.[4]
{{#ev:youtube|v=7l1f2-dF-QY}}
- Serial transverse enteroplasty (STEP): Bowel is cut and stapled in a zigzag pattern
{{#ev:youtube|v=Zjl7AjiyXwQ}}
- Transplant
- Isolated intestinal transplant
- Transplant
{{#ev:youtube|v=BSQYcrVE1vE}}
- Combined intestinal and liver transplant
References
- ↑ Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
- ↑ 2.0 2.1 2.2 Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. doi:10.1016/j.suc.2011.02.006. ISSN 0039-6109.
- ↑ Botey, Mireia; Alastrué, Antonio; Haetta, Henrik; Fernández-Llamazares, Jaume; Clavell, Arantxa; Moreno, Pau (2017). "Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases". Case Reports in Gastroenterology. 11 (1): 229–240. doi:10.1159/000452734. ISSN 1662-0631.
- ↑ 4.0 4.1 4.2 Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. doi:10.4103/1319-3767.82573. ISSN 1319-3767.
- ↑ Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
- ↑ Limketkai BN, Parian AM, Shah ND, Colombel JF (2016). "Short Bowel Syndrome and Intestinal Failure in Crohn's Disease". Inflamm. Bowel Dis. 22 (5): 1209–18. doi:10.1097/MIB.0000000000000698. PMID 26818425.