Institutional Experience with Spiral Intestinal Lengthening and Tailoring

Abstract

Aim: The aim of this study was to report our initial experience using spiral intestinal lengthening and tailoring (SILT) technique in selected cases of short bowel syndrome (SBS).

Materials and methods: We analyzed all cases of SBS underwent SILT in our unit since the introduction of the procedure in 2012. We retrospectively analyzed patients' demographics, pre- and postprocedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements. Data were compared using independent samples, Mann-Whitney's U-test.

Results: Five children with SBS underwent SILT between 2012 and 2017. Median age at procedure was 8.3 months (4.5-16). Preoperative small bowel length measured a median of 22 cm (17.5-50) with a median diameter of 4 cm (3.5-4.6). SILT allowed a median increase in length of 56% (10-15 cm; p = 0.03) and tailoring of the dilated segment providing a reduction in diameter of 50% (4.3-2.1 cm; p = 0.01). No major complications related to SILT were encountered and none of the children required further surgical intervention following a median follow-up of 26 months (14.5-41). Interestingly, we observed a significant reduction of PN requirement at 6 months (p = 0.008) associated with liver function preservation during the follow-up period.

Conclusion: In our experience, SILT is a promising adjunct in the surgical management of SBS. It can be used to tailor and lengthen mildly dilated segments of the bowel where other procedures are technically challenging, with a view to reduce the risk of intestinal failure associated liver disease and thereby improving chances for quality survival. Further studies are needed to investigate long-term outcomes of SILT in pediatric SBS.