Bobbi King, Sarah L. Almond, Sara Gozzini, Basem Khalil, Antonino Morabito

Royal Manchester Children's Hospital and the University of Manchester, Manchester, United Kingdom

Background: It has been thirty years since Bianchi introduced the technique that made intestinal lengthening possible.  The last three decades have seen lengthening procedures establish themselves as vital components of intestinal rehabilitation programs.

Aim: To determine patient outcomes for the two most commonly used lengthening procedures: the Bianchi procedure; and the serial transverse enteroplasty (STEP).

Methods: Pubmed and Embase were searched using the terms ‘intestinal lengthening’ and ‘bowel lengthening’.   Patient outcomes were extracted from each relevant paper using a set proforma.  The results were combined to create overall mean outcomes.  Mean outcomes were also calculated separately for the Bianchi procedure and the STEP.  Significance was tested with the independent T-test.

Results: Overall survival for the last thirty years is 83%. However survival for the last fifteen years has been 89% with no significant difference between the two procedures.  The Bianchi procedure has a higher rate of weaning patients who were static on PN using conservative measures: 55% vs. 48% and a higher rate of patients receiving transplants: 10% vs. 6%.  The STEP has a higher rate of complications: 0.26 vs. 0.15.  Length of follow up is significantly longer for the Bianchi procedure:  76 vs. 22 months and the impact that this could have had on our results must be considered.

Conclusion: Outcomes for intestinal lengthening procedures are very good, and increasingly so.  However further analysis is required in order to fully understand the relative strengths and weaknesses of each procedure.