>Cirugía y Cirujanos
>Year 2008, Issue 1
Robledo-Ogazón F, Becerril-Martínez G, Hernández-Saldaña V, Zavala-Aznar ML, Bojalil-Durán L
Multiple colonic anastomoses in the surgical treatment of short bowel syndrome. A new technique
Cir Cir 2008; 76 (1)
PDF: 116.80 Kb.
Background: Some surgical pathologies eventually require intestinal resection. This may lead to an extended procedure such as leaving 30 cm of proximal jejunum and left and sigmoid colon. One of the most important consequences of this type of resection is “intestinal failure” or short bowel syndrome. This complex syndrome leads to different metabolic and water and acid/base imbalances, as well as nutritional and immunological issues along with the problem accompanying an abdomen subjected to many surgical procedures and high mortality. Many surgical techniques have been developed to improve the patient’s quality of life.
Methods: We designed a non-transplant surgical approach and performed the procedure on two patients with postoperative short bowel syndrome with ‹40 cm of proximal jejunum and left colon.
Results: There are a variety of non-transplant surgical procedures that, due to their complex technique or high mortality rate, have not resolved this important problem. However, the technique we present in this work can be performed by a large number of surgeons. The procedure has a low morbimortality rate and offers the chance for better control of metabolic and acid/base balance, intestinal transit and proper nutrition.
||Short bowel syndrome, intestinal failure, non-transplant surgical technique.
Waddell WR, Kern F, Halgrimson CG, et al. A simple jejunocolic “valve.” For relief of rapid transit and the short bowel syndrome. Arch Surg 1970;100:438-444.
2. Ricotta J, Zuidcma FD, Gadacz RT, et al. Construction of an ileocaecal valve and its role in massive resection of the small intestine. Surg Gynecol Obstet 1981;152:310-314.
3. Stacchini A, Dido LJ, Primo ML, et al. Artificial sphincter as surgical treatment for experimental massive resection of small intestine. Am J Surg 1982;143:721-726.
4. Blanco BR, Niño SJ. Construction of a new intestinal valve. Dis Colon Rect 1994;37:606-609.
5. Persemlidis D, Kark AE. Antiperistaltic segments for the treatment of short bowel syndrome. Am J Gastroenterol 1974;62:526-530.
6. Hakami M, Moslehy A, Mosavy SH. Reversed jejunal segment used to treat the short bowel syndrome. Am Surg 1975;41:432-435.
7. Panis Y, Messing B, Rivet P, et al. Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome. Ann Surg 1997;225:401-407.
8. Trinkle JK, Bryant LR. Reversed colon segment in an infant with massive small bowel resection: a case report. J Ky Med Assoc 1967;65:1090-1091.
9. Thompson JS. Langnas AN. Surgical approaches to improving intestinal function in the short bowel syndrome. Arch Surg 1999;134:706-711.
10. Garcia VF, Templeton JM, Eichelberger MR, et al. Colon interposition for the short bowel syndrome. J Pediatr Surg 1981;16:994-995.
11. Glick PL, de Lorimier AA, Adzick NS, et al. Colon interposition: an adjuvant operation for short-gut syndrome. J Pediatr Surg 1984;19:719-725.
12. Brolin RE. Colon interposition for extreme short bowel syndrome: a case report. Surgery 1986;100:576-580.
13. Bianchi A. Intestinal loop lengthening a technique for increasing small intestinal length. J Pediatr Surg 1980;15:145-151.
14. Georgeson K, Halpin D, Figueroa R, et al. Sequential intestinal lengthening procedures for refractory short bowel syndrome. J Pediatr Surg 1994;29:316-320.
15. Thompson JS, Langnas AN, Pinch LW, et al. Surgical approach to short-bowel syndrome. Experience in a population of 160 patients. Ann Surg 1995;222:600-605.
16. Weber TR. Isoperistaltic bowel lengthening for short bowel syndrome in children. Am J Surg 1999;178:600-604.
17. Waag KL, Hosie S, Wessel L. What do children look like after longitudinal intestinal lengthening? Eur J Pediatr Surg 1999;9:260-262.
18. Thompson JS, Pinch LW, Young R, et al. Long-term outcome of intestinal lengthening. Transplant Proc 2000;32:1242-1243.
19. Bianchi A. Longitudinal intestinal lengthening and tailoring: results in 20 children. J R Soc Med 1997;90:429-432.
20. Devine RM, Kelly KA. Surgical therapy of the short bowel syndrome. Gastroenterol Clin North Am 1989;18:603-618.
21. Figueroa-Colon R, Harris PR, Birdsong E, et al. Impact of intestinal lengthening on the nutritional outcome for children with short bowel syndrome. J Pediatr Surg 1996;31:912-916.
22. Kim HB, Lee PW, Garza J, et al. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 2003;38:881-885.
23. Kim HB, Fauza D, Garza J, et al. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg 2003;38:425-429.
24. Tannuri U. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure, and serial transverse enteroplasty for short bowel syndrome. J Pediatr Surg 2003;38:1845.
25. Johansson K, et al. Increased bacterial transport in porcine small bowel mucosa after increased intra-abdominal pressure. ANZ J Surg 2005,75:10-11.
26. Grant JF. Duke procedure for super obesity: preliminary report with 3-5 years follow-up. Surgery 1994;115:718-726.
>Cirugía y Cirujanos
>Year 2008, Issue 1