2011 - ISBTS 2011 Symposium


Oral Communications 5: Long Term TPN and Rehab

7.139 - STEP procedure in children: Initial experience in Argentina

Presenter: Pablo, Lobos, Buenos Aires, Argentina
Authors: Pablo Lobos1,2, Verónica Busoni1,3, Anahí Salomón2, Rosana Vagni1,4, Mateo Ferrero1,5, Fernando Frangi1,6, Daniel Liberto1,2, Natalia Granados1,4,6, Rodrigo Sanchez Clariá1,7


139
STEP procedure in children: Initial experience in Argentina

Pablo Lobos1,2, Verónica Busoni1,3, Anahí Salomón2, Rosana Vagni1,4, Mateo Ferrero1,5, Fernando Frangi1,6, Daniel Liberto1,2, Natalia Granados1,4,6, Rodrigo Sanchez Clariá1,7

1Center for Intestinal Rehabilitation and Transplantation, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 3Pediatric Gastroenterology and Hepatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 4Pediatric Nutrition, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 5Pediatric Intensive Care, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 6Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 7Liver and Intestinal Transplantation Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Introduction: Small bowel transplantation (SBT) has become a solution for children with short bowel syndrome (SBS) and total parenteral nutrition (TPN) related complications, although long term complications of SBT still remain very high. In selected cases, bowel lengthening procedures may give an opportunity for avoiding the need of SBT. We report herein the initial experience with Serial Transverse Enteroplasty (STEP procedure) in children with SBS in our center.

Methods: Retrospective analysis of the Center for Intestinal Rehabilitation and Transplantation (CRIT) database from March 2008 to May 2011. Inclusion criteria: Children with SBS TPN- dependent for more than 3 moths, with a minimum bowel diameter of 5 cm. Data analysed: Age, body weight, underlying disease, TPN requirements, enteral feeding volume tolerated, pre and postoperative intestinal residual length (IRL), surgical complications and outcome.

Results: 32 patients were treated by our group during the study period. A STEP procedure was performed in 5 (15.6%). Median age: 16 months (r:5-22 m). Median weight: 6.1 kg (r:2.8-10.5). Diagnoses were: 2 gastroschisis and 3 intestinal atresias. % of enteral vs. parenteral feeds tolerated: 18.9% (r:0-60) preSTEP and 70.4% (r:25-100) postoperative (p 0.019). Mean increase in IRL postSTEP was 25.7 cm (r:8-55) or 65.4% (r:25.8-30.3%). Mean follow up: 14.2 months (r:8-23). There were no surgical complications. 1 patient (20%) is off-TPN at 11 months PO. 2 patients died, 8 and 23 months PO, because of infectious complications.

Conclusions: Surgical intestinal rehabilitation performing STEP procedure has become a good alternative for children with SBS. In our experience, it was useful for reducing the amount of TPN requirements by increasing enteral feedings, although it may not be enough for complete weaning of TPN in the short term. STEP procedure is safe and feasible, and could also constitute a bridge for intestinal transplantation in countries with shortage of pediatric donors.


You must be logged in to view recordings

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Our Corporate Sponsors

TTS gratefully acknowledges the Corporate Partners whose generous support makes the work of the Society possible:

  • astellas
  • roche
  • sanofi