The surgical management of massive bowel resection

Cywes, S.

doi:10.1016/0022-3468(68)90908-1

Cited by 22 publications

(2 citation statements)

References 13 publications

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“…AGIR is designed to increase intestinal transit time by altering bowel morphology to improve the intestinal length and maximize residual function. Several non-transplant surgical techniques for SBS have been attempted, [13][14][15][16][17][18] with improvement in survival rates up to 92% with weaning from PN in up to 91% of patients in some reports. 1 Nevertheless, a recent systematic review reports that the efficacy of the STEP and LILT procedures in weaning SBS patients from PN is around 50%, confirming that the outcome of SBS could be affected by multifactorial issues.…”

Section: Discussionmentioning

confidence: 99%

Combined procedures for surgical short bowel syndrome: experience from two European centres

Gigola

Coletta

Certini

et al. 2022

ANZ Journal of Surgery

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Background: Autologous gastrointestinal reconstructive surgery (AGIR) has become a key component of intestinal rehabilitation programs. However, the best surgical option for short bowel syndrome (SBS) remains unknown. This paper presents our experience using combined procedures as primary treatment. Methods: We collected data on SBS patients who underwent surgery from 2008 to 2021 in two tertiary European Centres. Combined procedures were defined as more than one technique used on the same patient. Charts were reviewed for demographics, type of procedures, complications, and outcomes. Data are presented as median and IQR. Wilcoxon signed rank was used for all paired analyses. Results: Twenty-one children (12 females) underwent combined procedures. Preoperative median small bowel length was 20 cm (IQR: 15-35 cm); after lengthening, it was 35.5 cm (IQR: 30.75-50.50 cm) (P < 0.001). Combined procedures were simultaneous in 15 patients and sequential in 6. At a median of 9.2 years (IQR: 7.55-9.78 years) follow-up, complications were three bowel obstructions after strictures of anastomosis and two wound infections. Two patients achieved enteral autonomy, and others followed a weaning home parenteral nutrition regimen with a median of 4 nights off (IQR: 3-4 nights) starting with a median of 7 nights (IQR: 7-7 nights). Conclusions: Combined AGIR techniques are practical and safe in SBS treatment when tailored to meet patients' needs, combining lengthening, tailoring, and reducing transit time procedures. Therefore, combined AGIR may be considered a resource in intestinal rehabilitation units' armamentarium.

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Section: Discussionmentioning

confidence: 99%

Combined procedures for surgical short bowel syndrome: experience from two European centres

Gigola

Coletta

Certini

et al. 2022

ANZ Journal of Surgery

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“…The first clinical application of the technique was reported in 1962 by Gibson et al ( 34 ), and Fink and Olson, in ( 35 ), described for the first time a case in which two different RSs was placed in the same patient ( 35 ). Cywes 1968, published the first pediatric experience of RS in an 18-month-old boy ( 36 ).…”

Section: Procedures To Slow Intestinal Transitmentioning

confidence: 99%

Autologous Intestinal Reconstruction Surgery in Short Bowel Syndrome: Which, When, and Why

et al. 2022

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Short bowel syndrome (SBS), secondary to any natural loss or after any extensive bowel resection for congenital malformations or acquired disease, is the most common cause of intestinal failure in children. Extensive introduction of parenteral nutrition (PN) has dramatically changed the outcome of these patients, allowing for long-term survival. The main goal in children with SBS remains to be increasing enteral tolerance and weaning from PN support. Post resection intestinal adaptation allows for achievement of enteral autonomy in a subset of these patients, but the inability to progress in enteral tolerance exposes others to long-term complications of PN. Autologous intestinal reconstruction surgery (AIRS) can facilitate the fulfilment of enteral autonomy, maximizing the absorptive potential of the remaining gut. All the different intestinal reconstruction techniques, from simple procedures like tapering, reversed segments, and colon interposition, to more complex lengthening procedures (LILT: longitudinal intestinal lengthening and tailoring, STEP: serial transverse enteroplasty, and SILT: spiral intestinal lengthening and tailoring) and techniques designed for peculiar problems like controlled intestinal tissue expansion or duodenal lengthening are presented. AIRS indications, clinical applications, and results reported in the literature are reviewed.

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