Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature

Abstract

Purpose: To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data.

Methods: A review of literature was performed. N=39 publications were reviewed.

Results: For LILT and STEP, failure to achieve intestinal autonomy by conservative therapy represents the main indication, and end-stage liver disease the main contraindication. A sufficiently dilated intestinal segment is a common anatomical precondition for both procedures. STEP can be performed on shorter intestinal segments and on intricate segments such as the duodenum, which is technically not feasible for LILT. Both procedures have a similar extent of intestinal lengthening (approximately 70%) and result in improvement of enteral nutrition and reversal of complications of parenteral nutrition. STEP seems to have a lower mortality and overall progression to transplantation.

Conclusions: STEP and LILT are both accepted procedures for non-transplant surgical management of SBS in children. The outcome after STEP seems to be more favourable, but larger series are needed to further assess accurate selection of eligible patients and to estimate effectiveness of procedures. A considerably higher number of cases for evaluation might be accomplished through the widespread use of a centralised registry.

Keywords: AIRS; Autologous Intestinal Reconstruction Surgery; Autologous intestinal reconstruction; Bianchi; Intestinal lengthening; LILT; Longitudinal Intestinal Lengthening and Tailoring; Not reported; PN; Parenteral Nutrition; SBS; SBTX; STEP; STP; Serial Transverse Enteroplasty; Short Bowel Syndrome; Short Bowel Transplantation; Short bowel syndrome; n.r.