Spiral intestinal lengthening and tailoring — first in vivo study

Cserni, Tamás; Varga, Garbriella; Érces, Dániel; Kaszaki, József; Boros, Mihály; László, A; Murphy, Fiona; Földvári, Anett; Morabito, Antonino; Bianchi, A.; Rakoczy, George

doi:10.1016/j.jpedsurg.2013.01.048

Cited by 37 publications

(34 citation statements)

References 15 publications

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“…Bowel length and diameter reduction to around 2 cm are achieved by longitudinal elongation and axial rotation with suture of contiguous cut edges over a large intraluminal guide tube. In their pig model Cserni et al [2] did not find any damage to the myenteric, submucosal and Cajal's plexuses. In a personal communication (presently awaiting publication) they report success with SILT in three children who have now established enteral autonomy, with a mean increase in length of around 75 % and a diameter reduction of [56 %.…”

Section: Discussionmentioning

confidence: 79%

“…The STEP procedure, reported by Kim in 2003, partially divides the dilated bowel transversely, serially and alternately in zigzag pattern using a transmesenteric approach with a possible increase in length of [100 % [7]. The STEP procedure [2,5] can be safely repeated in the event of recurrent significant bowel dilatation. A recent systematic review of both procedures by King et al [5] demonstrated a relatively low complication rate for obstruction, redilatation and perforation [1] at 17 % for the LILT Group and 26 % for the STEP group (p \ 0.02).…”

Section: Discussionmentioning

confidence: 99%

“…Despite successes with both techniques there remains a largely theoretical fear of mesenteric vessel injury during LILT, and concern of potential disruption to peristalsis because of alteration in the orientation of the small bowel muscle fibers by the STEP. In 2011, Cserni et al [1,2] published the SILT procedure that divides the bowel in spiral fashion at a 45°-60°angle running from the mesenteric to the antemesenteric borders. The 'spiral' passes through the avascular mesentery between the vessels reducing the fear of vessel injury, and retains the normal muscle layer orientation.…”

Section: Discussionmentioning

confidence: 99%

“…Spiral intestinal lengthening and tailoring (SILT) [1,2], first described by Cserni et al [1] in the laboratory and subsequently in three children (personal communication), is reputed to tailor and lengthen dilated small bowel with lesser risk to the mesenteric vessels that is a fear with longitudinal intestinal lengthening and tailoring (LILT) technique, and without altering the orientation of the intestinal muscle fibers that occurs with serial transverse enteroplasty (STEP). We report another child with postsurgical SBS who underwent bowel expansion followed by SILT at 10 months of age.…”

Section: Introductionmentioning

confidence: 99%

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“Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel

et al. 2014

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We report a child with post-surgical short bowel state who underwent bowel expansion followed by spiral intestinal lengthening and tailoring (SILT) at 10 months of age. Growth at 1-year follow-up is along the 15-25th centile on 82 % oral calories as normal diet and 18 % as parenteral nutrition, and he is passing 2-3 semisolid motions daily. SILT is a versatile technique for reconstructing dilated bowel towards improved propulsion and absorption, and has a role in the management of the short bowel state.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel

et al. 2014

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“…Intestinal Lenghtening): İlk kez 2013 yılında deneysel olarak tanımlandı (88) ve ilk klinik uygulaması da aynı ekip tarafından 2014 yılında, 3 yaşında bir volvulus olgusunda başarıyla gerçekleştirilmiştir (89) . Dilate bağırsağın uzun aksına 45-60° açı ile spiral insizyonlar yapılır bağırsak gerilerek insizyon hattınca dikilir.…”

Section: B Spiral Bağırsak Uzatma Yöntemi (Silt: Spiralunclassified

Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

Çelik¹

2017

tcdd

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Öz GirişBağırsak sisteminin bireyin besin alımı ve sıvı dengesini sağlamada yetersiz kaldığı durumlara bağırsak yetmezliği adı verilmektedir. Bağırsak uzunluğunun azaldığı, ileoçekal valvin olmadığı, kolonun kaybedildiği gibi uzunluk kayıpları veya mukozal yetmezlik, dismotilite veya aktif enterit gibi besin emiliminin mümkün olmadığı durumlarda birey kalıcı veya uzun süreli total parenteral beslenmeye mecbur kalabilmektedir (1) . "Büyüme için gerekli sıvı ve besinlerin sindirimi ve emilimi için yeterli miktarda fonksiyonel bağırsak kalmaması" pediatrik bağırsak yetmezliğinin modern tanımlamasıdır. Bir başka tanımda ise, büyüme, hidrasyon ve elektrolit homeostazının bozulmasına neden olan bağırsak hastalığı olarak genellenebilmektedir.

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Results of Surgical and Medical Rehabilitation for Adult Patients With Type III Intestinal Failure in a Comprehensive Unit Today: Building a New Model to Predict Parenteral Nutrition Independency

Gondolesi

Doeyo

Lic

et al. 2019

J Parenter Enteral Nutr

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Background: Short-bowel syndrome remains the primary cause of intestinal failure (IF) in adult patients. We aim to report the long-term results of medical and surgical rehabilitation in a cohort of patients with type III IF (III-IF) and develop a formula to predict parenteral nutrition (PN) independency. Methods: We used a retrospective analysis of a prospective database for III-IF patients undergoing autologous gastrointestinal reconstruction surgery (AGIRS) from March 2006 to August 2018. Analyzed variables included demographic data, postsurgical intestinal length (PSIL), postsurgical anatomy, teduglutide (TED) treatment, and PN volume reduction. Univariate analysis, Cox regression, logistic regression forward stepwise models, and receiver operating characteristic (ROC) curve were done using SPSS v20. Results: AGIRS was performed in 88 patients. The most frequent anatomy at first visit was type 1. Prevailing anatomy after surgery was type 3. Eight patients started TED; 6 achieved freedom from PN. At a mean follow-up time of 1606.1 ± 1190.25 days, freedom from PN survival was achieved in 83%. Variables identified at the logistic regression analysis led to a novel formula to predict intestinal rehabilitation, including PSIL, presence of ileocecal valve, and use of TED as part of postsurgical treatment. Conclusions: AGIRS in this group of patients enabled intestinal length increase and also intestinal anatomy conversion into a more favorable type for intestinal rehabilitation. TED treatment was useful to discontinue PN in patients with classical negative anatomical predictors. The novel predicting formula has an ROC area under the curve = 0.82. Further studies are necessary to validate this formula.

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Spiral intestinal lengthening and tailoring — first in vivo study

Cited by 37 publications

References 15 publications

“Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel

“Spiral intestinal lenghtening and tailoring (SILT)” for a child with severely short bowel

Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

Results of Surgical and Medical Rehabilitation for Adult Patients With Type III Intestinal Failure in a Comprehensive Unit Today: Building a New Model to Predict Parenteral Nutrition Independency

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