Double barrel enteroplasty for the management of short bowel syndrome in children
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Double barrel enteroplasty for the management of short bowel syndrome in children Albert Shun1,2,4 · Gordon Thomas1,2 · Juliana Puppi3 · Erik La Hei1,2 · Catherine Langusch1,2 Accepted: 11 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Currently, there are two well-established methods of bowel lengthening in patients with short bowel syndrome (SBS)-longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) [1–4]. Both procedures may carry a high reported morbidity and mortality of 30.2% and 14.4%, respectively [5]. We report the outcomes of a novel technique: double barrel enteroplasty (DBE) for autologous intestinal reconstruction. Methods We performed a retrospective review of all ten patients who underwent DBE at our institution since 2011. All patients have SBS and were dependent on parenteral nutrition (PN) at the time of surgery. Etiologies were gastroschisis (n = 4), bowel atresia (n = 3), necrotising enterocolitis (n = 1), volvulus (n = 1), and near-total intestinal aganglionosis (n = 1). Patient survival, complications, and subsequent enteral autonomy were evaluated. Results All patients are alive with normal liver function. Five children achieved enteral autonomy, while the remaining are on weaning PN. There was no bleeding, anastomotic leak, perforation, infective complications, or intestinal necrosis. No patient has required a liver and/or intestinal transplant. Conclusions Double barrel enteroplasty is technically feasible and safe. It has similar efficacy and may have fewer complications when compared with other methods of autologous intestinal reconstruction. Keywords Intestinal failure · Short bowel syndrome · Bowel lengthening · Enteral adaptation · Double barrel enteroplasty
Introduction Autologous intestinal reconstruction surgery has significantly improved the chance of intestinal autonomy in children with short bowel syndrome (SBS) [1]. Currently, the two most commonly used procedures of bowel lengthening in children are longitudinal intestinal lengthening and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00383-020-04767-0) contains supplementary material, which is available to authorized users.
tailoring (LILT) [2] and serial transverse enteroplasty (STEP) [3, 4] pioneered by Bianchi and Kim, respectively. However, these can be high-risk procedures with not insignificant morbidity and mortality [5]. The concept of double barrel enteroplasty (DBE) originated in 2008 when author AS successfully treated an infant with total colonic duplication in Papua New Guinea during one of his humanitarian visits. A baby girl presented with a type II colonic duplication [6], but it was atypical in that only one end of the distal hemi-colon connected with her vagina and the other
* Albert Shun [email protected]
1
Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, NSW, Australia
Gordon Thomas
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