Short bowel syndrome surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

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 from parenteral nutrition. Patients who have severe or worsening malabsorption might require surgery including intestinal transplant. Transplant is contraindicated in patients with active infection or malignancies. Approximately half of the patients with short bowel syndrome will require surgery. Bianchi procedure and serial transverse enteroplasty (STEP) are performed to lengthen dilated bowel. Stricturoplasty might be necessary. Intestinal transplant is reserved for patients who have life-threatening complications of intestinal failure, irreversible permanent total parenteral nutrition requirement and episodes of sepsis or loss of venous access.

• Surgery is not the first-line treatment option for patients with short bowel syndrome.^{[1][2][3][4][5]}
• The primary goal of surgery is to restore absorption capacity of the small bowel.^[6]
• Surgery is usually reserved for patients with either:^[7][8][9]
  • 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:^[7][10]
  • 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

Transplant is contraindicated in patients with either:^[7][11]

Absolute contraindications:

• Active infection
• Malignancies

Relative contraindications:

• Reduced neurodevelopment
• Psychosocial factors

• Approximately half of the patients with short bowel syndrome will require surgery. However, there is controversy over the efficacy of these procedures.^{[12][11][13][14]}
• These procedures are usually performed by pediatric surgeons at a quaternary hospital specializing in small bowel surgery.^[15]
• There are two categories of surgery for short bowel syndrome including non-transplant and transplant interventions.^[10]

• Stricturoplasty 
• Surgical procedures to lengthen dilated bowel
  • Bianchi procedure: Bowel is cut in half and one end is sewn to the other

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• Serial transverse enteroplasty (STEP): Bowel is cut and stapled in a zigzag pattern^[8]

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• Isolated intestinal transplant

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• Combined intestinal and liver transplant

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