Efficacy of autologous intestinal reconstruction surgery on bowel dilatation in pediatric small bowel syndrome.

OBJECTIVES

Pediatric short bowel syndrome (SBS) may cause excessive bowel dilatation leading to worsened outcomes and autologous intestinal reconstruction (AIR) surgery. We addressed efficacy of AIR surgery by measuring duodenal, small bowel and colon dilatation in SBS children with and without AIR surgery in relation to parenteral nutrition (PN) dependency and healthy control patients.

METHODS

SBS children having undergone AIR surgery (AIR+, n = 22) and those without AIR surgery (AIR-, n = 56) were included. Intestinal contrast series performed between 2002 and 2020 were analyzed to measure diameter of duodenum, small bowel, and colon, and their postoperative changes. Results were expressed as diameter ratio (DR) standardized to L5 vertebrae height. Previously established cutoff values for abnormal bowel dilatation in unoperated SBS patients and healthy controls were used for comparison.

RESULTS

AIR+ patients had shorter remaining bowel and less frequently ileocecal valve (ICV) preserved. Preoperatively, only small bowel DR (SBDR) was weakly associated with the need for AIR surgery. SBDR decreased significantly (p < 0.05) by 30 % after AIR surgery, while no significant decrease of DR was observed in duodenum or colon. Over half of AIR+ patients whose SBDR decreased after surgery (69 %), weaned off PN during median follow-up of 7.2 years (3.6-16). Patients with postoperative reduction of SBDR to the degree of unoperated SBS patients were more likely to wean off PN.

CONCLUSIONS

Our findings suggest that bowel dilatation is unreliable sole indication for AIR surgery, while effective postoperative reduction of dilatation was associated with weaning off PN.