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Review
. 2022 Apr 1;27(2):112-118.
doi: 10.1097/MOT.0000000000000957.

Comparing bowel lengthening procedures: which, when, and why?

Jasper B van Praagh  1 , H Sijbrand Hofker, Jan-Willem Haveman
Affiliations
Review

Comparing bowel lengthening procedures: which, when, and why?

Jasper B van Praagh et al. Curr Opin Organ Transplant. .

Abstract

Purpose of review: Intestinal failure secondary to short bowel syndrome is still a very serious condition. Treatment consists of parenteral nutrition to provide nutrients and maintain body weight. During the last decades, intestinal lengthening procedures have become more available. The goal of this review is to discuss the results of the literature on the most commonly performed intestinal lengthening procedures.

Recent findings: Longitudinal Intestinal Lengthening, Serial Transverse Enteroplasty (STEP), and Spiral Intestinal Lengthening and Tailoring (SILT) are currently the most frequently reported intestinal lengthening procedures. The most recent literature of these procedures is described with respect to indication, technical details, complications, short and long-term outcome, and PN independence.

Summary: On the basis of indication, surgical complexity, complications, and clinical success, we conclude that the STEP procedure is probably the best choice for most centers.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Bianchi procedure or LILT. (a) separating the two leaves of the mesentery of the isolated small bowel segment. (b) Creating a funnel on the mesenteric site for dividing the small bowel. (c), (d) Separating the small bowel by introducing a surgical stapler. This can also be done by cutting the bowel half. (e) The two bowel loops are then anastomosed together in an isoperistaltic manner. ILT, Longitudinal Intestinal Lengthening. Reproduced with permission [1].
FIGURE 2
FIGURE 2
Schematic view of STEP. Perpendicular to the longitudinal axis, a stapler line is made preserving a 2 cm luminal diameter. After multiple staples, the bowel is lengthened. STEP, Serial Transverse Enteroplasty. Reproduced with permission [27].
FIGURE 3
FIGURE 3
A model of the SILT technique. (a) The bowel is cut spirally in an angle to the longitudinal axis. (b) maintaining orientation by using a silicon catheter, the bowel is stretched. (c) When adjusted to the right length and diameter, the lumen is closed by suturing. (d) The bowel in a longer and narrower shape. SILT, Spiral Intestinal Lengthening and Tailoring. Reproduced with permission [28].
See this image and copyright information in PMC

References

    1. Bianchi A. Intestinal loop lengthening—a technique for increasing small intestinal length. J Pediatr Surg 1980; 15:145–151. - PubMed
    1. Bianchi A. Intestinal lengthening: an experimental and clinical review. J Roy Soc Med 1984; 77: (Suppl 3): 35–41. - PMC - PubMed
    1. Capriati T, Mosca A, Alterio T, et al. . To wean or not to wean: the role of autologous reconstructive surgery in the natural history of pediatric short bowel syndrome on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP). Nutrients 2020; 12:2136. - PMC - PubMed

    2. Review paper on the autologous gastrointestinal reconstruction surgery. The paper gives an extensive overview on all papers on the several bowel lengthening procedures and describe their results on outcome and complications.

    1. Shah AA, Petrosyan M, Franklin AL, et al. . Autologous intestinal reconstruction: a single institution study of the serial transverse enteroplasty (STEP) and the longitudinal intestinal lengthening and tailoring (LILT). Pediatr Surg Int 2019; 35:649–655. - PubMed
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