Small Bowel Dilatation in Pediatric Intestinal Rehabilitation Patients: Surgical Aspects and Proposal of a Treatment Algorithm

Matthias Schunn1 , Andreas Busch2 , Nalan Darwish1 , Simon Scherer1 , Ilias Tsiflikas3 , Steffen Hartleif2 , Jens Gesche1 , Ekkehard Sturm2 , Johannes Hilberath2 , Matthias Kumpf4 , Jörg Fuchs1 and Steven W Warmann1 *

Department of Pediatric Surgery and Pediatric Urology, University Children?s Hospital Tuebingen, Germany 2 Department of Pediatric Gastroenterology and Hepatology, University Children?s Hospital Tuebingen, Germany 3 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany 4 Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children?s Hospital Tuebingen, Germany

^*Correspondance to: Steven Warmann 

 PDF  Full Text DOI: 10.25107/2474-1647.3158

Abstract

Background: Standardization of surgical indications and procedures concerning bowel dilatation in children with Short Bowel Syndrome (SBS) is difficult due to the variety of individual patient conditions. Aim of this study was to analyze surgery for bowel dilatation in children with SBS treated within our pediatric Intestinal Rehabilitation Program (pIRP). Methods: We retrospectively analyzed data of our pIRP patients undergoing surgery for dilated bowel between 11/2010 and 12/2019. Analysis comprised patients? data, surgical data, and outcome. Results: There were 47 pIRP patients undergoing surgery for bowel dilatation. Most common indications for surgery were bowel/anastomotic stenosis (n=20) and stenotic enterostomies (n=15). Most common procedures were stenosis resection with re-anastomosis (n=26), stoma revision (n=9), bowel tapering (n=9), Serial Transverse Enteroplasty (STEP, n=5), and stricturoplasty (n=4). After a median follow-up of 33 months (0-166), 8 patients achieved complete enteral autonomy, 15 patients were fed predominantly via the enteral route. Seven children needed redo-surgery for intestinal stenosis. Conclusion: An interdisciplinary approach for the management of children with SBS and bowel dilatation is crucial. Bowel motility represents an essential aspect of the surgical decision making process regarding indications and techniques. We propose an algorithm for the management of pIR patients with bowel dilatation.

Keywords

Short bowel syndrome; Bowel dilatation; Intestinal rehabilitation

Cite the article

Schunn M, Busch A, Darwish N, Scherer S, Tsiflikas I, Hartleif S, et al. Small Bowel Dilatation in Pediatric Intestinal Rehabilitation Patients: Surgical Aspects and Proposal of a Treatment Algorithm. Clin Surg. 2021; 6: 3158..