Intestinal Rehabilitation and Bowel Reconstructive Surgery

Abstract

Our series shows improved results not only with survival but also in the number of patients that are off TPN. Multidisciplinary approach consisting of both medical and surgical expertise is necessary in the management of these patients. The authors advocate centralisation of short gut services to experienced centers with multidisciplinary expertise.

Gastroschisis and the Risk of Short Bowel Syndrome: Outcomes and Counselling

“…A retrospective review of 64 patients however found no correlation between antenatal scan features and postnatal viable bowel length [5]. Many gastroschisis also demonstrate mild intra-abdominal bowel dilatation, which is not consistent with postnatal SBS [4]. Whilst the above features are useful for antenatal counselling it is unlikely that they will determine whether preterm delivery is indicated to salvage bowel length.…”

“…Tube stomas were formed for controlled tissue expansion and colonic recycling of jejunal contents ensued. Following AGIR [4,] enteral feeding was introduced on day 5 and increased as tolerated. PN was consequently decreased and stopped 6 months following surgery.…”

“…A diagnosis of vanishing gastroschisis was made. The child has been enrolled on the IRP and is currently undergoing active tissue expansion as per the protocol [4]. …”

“…Long-term PN and catheter-related infection can be associated with liver fibrosis and cirrhosis, alternatively referred to as intestinal failure associated liver disease (IFALD). A valid alternative treatment for these patients is non-transplant surgery with autologous gastrointestinal reconstruction (AGIR) to increase mucosal surface area, and hasten adaptation [4]. …”

Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

“…Kısa bağırsak sendromu denebilmesi için geleneksel olarak 40 cm ve daha az miktar bağırsak varlığı yanısıra kimi merkeze göre 42 gün (2) , kimine göre 3 ay, kimine göre ise 6 aydan daha uzun süren total parenteral beslenme gereksinimi olmalıdır. Ayrıca gestasyonel yaş, hastanın KBS olduğu aktuel zamanlamanın ve altta yatan patolojinin de göz önüne alınması gerektiği vurgulanmaktadır (3,4) .…”