STEP procedure in short bowel syndrome: 16 procedures in 13 children
Pablo Lobos1, Silvana Prodan1, VerÃ³nica Busoni1, Laura Ungar1, Daniel Liberto1, Fernando Frangi1, Rodrigo Sanchez ClariÃ¡1
1Center for Intestinal Rehabilitation and Transplantation (C.R.I.T.), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
In the last decades, intestinal transplantation (ITx) has become a reality for children with short bowel syndrome (SBS), although its morbidity and mortality still remains high. STEP procedure has been introduced to improve enteral tolerance avoiding the need of an ITx. We report herein our experience with this surgical procedure in children with SBS.
MATHERIAL AND METHODS:
A cases series of childen with SBS who underwent a STEP procedure was retrospectively analyzed from our database. Study period was March 2008 to February 2013. Indications for surgery were: TPN dependant patients, unable to achieve enteral autonomy with medical treatment, who also had significant bowel dilatation. Age, weight and underlying disease, TPN requirements, enteral volume tolerance, intestinal length before and after the procedure, surgical complications and outcome were analyzed.
50 pediatric patients were referred to our center during the study period. STEP procedure was performed in 13 (26%), with 3 re-STEPs. Mean age at surgery was 14,2 months (r: 5-32) and mean weight 7.830 kg (r: 3.8-17). Mean time interval between procedures in Re-STEP pts was 12,6 months (r: 10-17). Underlying disease: gastroschisis (6), atresia (6), and necrotizing enterocolitis (1). Mean increase in residual intestinal length was 27cm (r: 8-75) or 47,35% (r: 9,3-96,1) of the initial length. Re-STEP procedures had a medium increase of 17,9% (r: 9,3-27,1). Follow up: 15.8 months (r:0,5-35). Complications (3): intraoperative shock assumed as latex allergy (1), intraperitoneal bleeding (2). No surgery- related mortality was recorded. 3 patient (23%) died at 6, 12 and 14 months. 7/13 pts (53.8%) are currently off TPN.
Surgical intestinal rehabilitation through STEP technique has become a good alternative to rescue children with SBS. In our experience, it has been useful to enhance enteral tolerance and decrease TPN dependance. Although not exent from complications, STEP procedure is reproducible and may even avoid the need of ITx.