Early improvement in intestinal function after isoperistaltic bowel lengthening

Abstract

Isoperistaltic bowel lengthening (the Bianchi procedure) has been used increasingly in the management of infants and children with short bowel syndrome. Although clinical improvement is observed frequently, few studies document the early effects of the Bianchi procedure on nutrient absorption and transit time. Five infants and children (aged 3 months to 4 years) with profound short bowel syndrome (< 50 cm of small bowel) underwent isoperistaltic bowel lengthening (10 to 40 cm) when their bowel was greater than 3 cm in diameter. One to 2 weeks preoperatively, the following were obtained for each patient: 24-hour stool counts, transit time (charcoal), intestinal clearance of barium, and nutrient absorption (fat balance and D-xylose). The studies were repeated 1 and 6 months postoperatively. The mean stool count per 24 hours decreased from eight preoperatively to four and three at 1 and 6 months postoperatively. Transit time increased from 52 minutes to 135 and 205 minutes, and clearance of barium improved from 4.5 hours to 2.4 and 2.6 hours, respectively. Results of D-xylose absorption and dietary fat balance studies, both abnormal preoperatively, also normalized at 1 and 6 months. These data show that the Bianchi procedure provides short- and intermediate-term improvement in intestinal and nutrient absorption, which should allow more rapid weaning from parenteral nutrition.