Repeat serial transverse enteroplasty leads to reduction in parenteral nutrition in children with short bowel syndrome

David F. Mercer, Tyler R. Burnett, Brandy D. Hobson, Samantha J. Logan, Brandi K. Gerhardt, Sarah N. Iwansky, Ruben E. Quiros-Tejeira

Research output: Contribution to journalArticle

Abstract

Background/purpose: Following a serial transverse enteroplasty (STEP) procedure some children develop redilation of the small intestine leading to impaired enteral tolerance and inability to wean parenteral nutrition (PN). The benefit of a second STEP procedure (2STEP) has been controversial. Methods: We performed a retrospective review of our experience (2008–2018) performing 2STEP, with comparative analysis of nutritional outcomes pre- and postsurgery. Results: During this period 2STEP was performed in 23 patients (13 F:10 M) at a median (25%–75%) age of 2.2 (1.2–3.6) years. Median intestinal length was 68 (40–105) cm before and 85 (40–128) cm after 2STEP. Leading up to 2STEP, PN provided almost 75% of estimated calorie needs. By 24 weeks following 2STEP drops in mean PN percent approached statistical significance (p = 0.07) and at most recent follow up the mean PN percentage was statistically better than at the time of operation or 4 weeks prior to 2STEP, and was nearly significant compared with 12 weeks (p = 0.07) and 24 weeks (p = 0.06) prior. Thirteen children were completely off parenteral support. Conclusion: When small intestine redilation occurs following a STEP procedure and where PN cannot otherwise be weaned we believe these data support performing a 2STEP. We cannot predict preoperatively which children will ultimately benefit. Level of evidence: 3 (retrospective comparative study).

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - 2020

Keywords

  • Intestinal failure
  • Parenteral nutrition
  • Pediatrics
  • STEP
  • Serial transverse enteroplasty
  • Short bowel syndrome

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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