The surgical management of short bowel syndrome

Abstract

Short bowel syndrome is a clinical entity that results from a diverse group of congenital and acquired conditions in the pediatric population. The pathophysiology of this syndrome is characterized by malabsorption, malnutrition, and metabolic disturbances. The vast majority of children with this condition undergo spontaneous adaptation of the intestinal remnant and achieve enteral nutritional autonomy. However, a small portion of pediatric patients develop intestinal failure and require long-term or permanent dependence on total parenteral nutrition. These children may benefit from surgical interventions that facilitate intestinal adaptation. Such adjunctive procedures facilitate nutrient absorption by improving motility, prolonging intestinal transit, and/or increasing mucosal contact time. In selected patients, this may allow them to be weaned from parenteral nutritional support or to have it discontinued. The purpose of this review is to discuss the various surgical techniques for the management of short bowel syndrome in children, along with their indications, complications, and outcomes.