Small bowel reversal procedure for treatment of the “short gut” baby

Warden, M. James; Wesley, John R.

doi:10.1016/s0022-3468(78)80407-2

Cited by 31 publications

(5 citation statements)

References 5 publications

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“…Medical management to bring patients back, or closer, to enteral autonomy includes infusion of parenteral fluid, electrolytes, and nutrition while medications are employed to control symptoms and fluid balance, and enteral nutrition is advanced to promote bowel adaptation (4,(26)(27)(28). Surgical interventions to help promote intestinal adaptation and enteral autonomy may include feeding enterostomies, ostomy closure following prior bowel resection, procedures to slow intestinal transit (29)(30)(31), and intestinal lengthening procedures such as serial tapering enteroplasty (STEP) or Bianchi procedures (32)(33)(34)(35)(36)(37). Patients who fail medical and surgical therapy, those with little potential for IR, or those who develop intractable complications become potential candidates for intestinal transplantation.…”

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confidence: 99%

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

Merritt

Cohran

Raphael

et al. 2017

J. pediatr. gastroenterol. nutr.

147

141

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Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. Intestinal rehabilitation programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life.

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confidence: 99%

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

Merritt

Cohran

Raphael

et al. 2017

J. pediatr. gastroenterol. nutr.

147

141

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“…One of these procedures is reversing an intestinal segment (antiperistaltic intestinal segment). This method has been proved effective experimentally (5) and clinically (1,7,8), but the morphologic effects of the reverse-segment procedure on the intestine have not been completely investigated. In this study, the effects of reverse intestinal-segment procedure on intestinal morphology in rats with SBS were investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Transient symptoms of obstruction and anastomotic leaks are potential complications (5,8). Warden and Wesley (1) performed a 3‐cm small‐bowel reversal procedure in five babies with short gut. Early after surgery, the patients did well and intestinal transit time increased, but the patients were not weaned from total parenteral nutrition until 1.5 years after surgery.…”

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confidence: 99%

“…Short bowel syndrome (SBS) is generally defined as a state wherein a patient's small intestinal length is inadequate for normal growth and development with enteral feeding. Clinical course after massive intestinal resection depends on the length of the remaining intestine, the site of the resected intestine, whether the ileocecal valve is present, total parenteral nutrition-related complications, and the primary disease causing SBS (1)(2)(3).…”

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confidence: 99%

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Does Ileal Reverse Segment in Rats With Short Bowel Syndrome Change Intestinal Morphology?

Şencan,

Akçora,

Mir

et al. 2002

J. pediatr. gastroenterol. nutr.

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BackgroundThe primary goal of surgical therapy for short bowel syndrome is to increase intestinal absorptive capacity. Many surgical procedures have been described for this purpose. One of these is ileal reverse‐segment procedure. This procedure after massive small‐bowel resection is an alternative way to treat short bowel syndrome, but how it affects intestinal morphology in short bowel syndrome has not been investigated. The aim of this study is to investigate macroscopic and microscopic effects of reverse‐segment procedure on the short bowel.MethodsTwenty rats underwent resection of 80% of the small bowel. The rats were separated into two groups (n = 10). In the first group (reverse group), a reverse segment was formed by twisting a 2‐cm ileal segment 180°, without damaging its vascularity. In the second group (control group), a 2‐cm ileal segment was resected, preserving its mesentery, and end‐to‐end anastomosis was performed to maintain the intestinal passage. The segment was not twisted 180°. The 2‐cm proximal (jejunal) and distal (ileal) segments of the resected bowel were reserved for histologic investigation. Two months later, the rats were killed and the jejunal and ileal segments were evaluated morphologically.ResultsIn the reverse group, body weight and total intestinal length significantly increased (14% more than in the control group). The diameter of both proximal (jejunal) and distal (ileal) segments in the reverse group also increased 53.8% and 22.8%, respectively (P < 0.05). Histologically, crypt depth and villus height of the ileal segment in the reverse group increased 15.2% and 18.2% more than in the control group (P < 0.05). No histologic change was observed at the jejunal level except for intestinal muscle thickness.ConclusionsIleal reverse‐segment procedure in rats with short bowel syndrome 1) does not cause intestinal obstruction, 2) increases total bowel length and body weight, 3) increases the diameter of both jejunal and ileal segments, and 4) increases villus height and crypt depth only at the ileal level. For this reason, reverse‐segment procedure positively affects intestinal adaptation.

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“…While 10 cm seems to be the most common length utilized in adult patients, beneficial effects have been described in infants when as little as 3 cm has been reversed. 9 Technically, the reversed segment should be placed as distally as possible maximize the length of proximal bowel that can benefit from the slowed transit and enhanced mucosal absorption. Reversed segments may have limited applicability in patients with extreme SBS, as construction of the reversed segment may compromise an already tenuous absorptive mucosal mass.…”

Section: Introductionmentioning

confidence: 99%

Surgical options to enhance intestinal function in patients with short bowel syndrome

Sommovilla

Warner

2014

Current Opinion in Pediatrics

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Purpose of review This review will provide the practitioner with an understanding of the spectrum of non-transplant surgical options for managing patients with short bowel syndrome. Recent findings Intestinal lengthening procedures are promising therapy to allow for autonomy from parenteral nutrition. The recently described serial transverse enteroplasty is an effective procedure that is easier to perform and has similar outcomes to the more standard longitudinal lengthening procedure described by Bianchi. Summary There are several surgical options for management of the short bowel syndrome and include construction of intestinal valves or reversed intestinal segments, interposition of segments of colon, or intestinal lengthening procedures. The choice of technique is dictated by the patients underlying pathophysiology and includes such factors as intestinal transit time, length of remnant bowel, presence of intact colon, and degree of small bowel dilation. Non-transplant surgical interventions are important adjuncts to the elimination of parenteral nutrition dependence and need for intestinal transplantation.

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Small bowel reversal procedure for treatment of the “short gut” baby

Cited by 31 publications

References 5 publications

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

Does Ileal Reverse Segment in Rats With Short Bowel Syndrome Change Intestinal Morphology?

Surgical options to enhance intestinal function in patients with short bowel syndrome

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