Non-transplant surgical networking in the management of intestinal failure: a 2-year review

Ingo Jester¹

¹Paedatric Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom

Background: It is well recognized that a multidisciplinary team approach is the key factor in optimizing the outcome of complex children with intestinal failure. Surgical bowel lengthening procedures can play an important role in achieving enteral autonomy. Aim of the study was to evaluate the effect of performing lengthening procedures in patients referred for assessment to our interdisciplinary group either in our center or in the patient’s local hospital.

Methods: Retrospective review of 33 patients with intestinal failure referred to our center for interdisciplinary discussion between January 2011 and December 2012. 

Results: Ten children were patients of our own center, twenty three patients were referred from UK, Ireland and Netherlands. Seven children in total underwent a small bowel lengthening procedure (Bianchi/STEP) performed by the same surgeon. Four patients were operated in our center, three children had their lengthening procedure in their local hospital. Non of the children had a surgical complication as in bleeding, wound infection, anastomotic leakage or adhesional obstruction. All patients could be weaned from parenteral nutrition but haven’t achieved full enteral autonomy yet. Two of the patients operated in our center underwent a combined small bowel and liver transplantation within one year following non-transplant surgery because of liver failure.

Conclusion: Optimized management of children with intestinal failure requires expertise of a interdisciplinary coordination of medical and dietetic support, surgical non-transplant procedures and intestinal transplantation. Small lengthening procedures can be challenging in this complex patient group. However it is safe to perform those procedures in the local environment of the patient. Particularly the children and their families benefit from the close networking with the local medical and surgical team.