Restoring gut physiology in short bowel patients: from bench to clinical application of autologous intestinal reconstructive procedures

ABSTRACT

Introduction: Short bowel syndrome represents the leading etiology that causes intestinal failure both in children and adults. Total parenteral nutrition support has dramatically improved the prognosis for these patients but, if related irreversible complications occur, the alternative is represented by surgery and/or transplantation.

Areas covered: Autologous gastrointestinal reconstructive procedures are a feasible, alternative approach with good long-term outcome data inexperienced surgical centers.

Expert opinion: Ongoing innovative efforts have driven the surgical options for successful autologous reconstructive surgery: bowel elongation/tapering techniques (LILT, STEP, and the new SILT) together with the ‘reversed bowel segment’ procedure are now recognized procedures and all must be tailored to the individual patient needs to obtain the optimal result in terms of enteral autonomy. Background laboratory experimentation with new procedures e.g. options for bowel dilation techniques and distraction-induced enterogenesis, may provide additional management and treatment modalities.

KEYWORDS:

• Short bowel syndrome
• bowel rehabilitation
• parenteral nutrition
• surgical rescue
• experimental surgery

Article highlights

• SBS is a severe and rare disease that needs high-specialized centers to deliver the best possible care. Multidisciplinary approach is the key of success, using a very individualized patient-centered approach.

• Since their conception, autologous gastrointestinal reconstructive surgeries have improved significantly the survival of the SBS patients, but these procedures required a experienced surgeon to be performed optimally.

• LILT, STEP, ‘REVERSED BOWEL SEGMENT’ and the new SILT are procedures for the surgical management of the SBS but they have specific indications for the respective use. The role of the intestinal reconstructive surgeon is to perform the correct procedure for the right patient, basing the decision on remnant bowel length, rate of intestinal dilation, mesentery condition and the percentage of bowel length expected.

• The final goal of LILT, STEP, ‘REVERSED BOWEL SEGMENT’ operation and SILT is to restore adequate bowel physiology in spite of the overall starting length of the shortened bowel.

Acknowledgments

We wish to thank Dr Joanna Catherine Gillham for her English language revision of the text and Ms Caterina Sommariva for her support in drafting two drawings (Figure 3 about “STEP” and Figure 5(a–b) about “Reversed Segment”).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject, matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.