Outcomes in patients with short bowel syndrome after autologous intestinal reconstruction: Does etiology matter?
BACKGROUND
Short bowel syndrome (SBS) is the most common cause of intestinal failure in children. Many factors have been investigated in an attempt to define which parameters influence most survival and ability to wean off parenteral nutrition (PN). The aim of this study was to investigate if aetiology of SBS affects the outcomes in paediatric patients treated with autologous gastrointestinal reconstructive surgery.


METHODS
All children with SBS who underwent autologous gastrointestinal reconstructive surgery between 2002 and 2012 were retrospectively reviewed and outcome measures were recorded.


RESULTS
Forty-three patients were divided into 4 groups according to aetiology (gastroschisis, volvulus, necrotizing enterocolitis (NEC), intestinal atresia). No significant differences were found among groups regarding survival and median age at surgery. The volvulus group had a lower pre-operative bowel length in comparison with gastroschisis and intestinal atresia and the lowest percentage of patients off PN (30%). Gastroschisis had the lowest rate of preserved ileocaecal valve (10%), while intestinal atresia had the highest (66%). For children who weaned off PN, intestinal atresia had also the longest time to achieve enteral autonomy (14.5months), while NEC had the shortest (3.5months), followed by gastroschisis (8.5months). None of the patients needed transplant.


CONCLUSIONS
In our experience it does not appear that diagnosis is significantly related to outcome and this is consistent with the conclusions of other reviews. However, it should be noted that in our series patients with volvulus had the worse outcome in terms of weaning off PN when compared with intestinal atresia.


TYPE OF STUDY
Retrospective Study.


LEVEL OF EVIDENCE
II.
['Pederiva|Federica|F|', 'Sgrò|Alberto|A|', 'Coletta|Riccardo|R|', 'Khalil|Basem|B|', 'Morabito|Antonino|A|']
D002648:Child D002675:Child, Preschool D020345:Enterocolitis, Necrotizing D005260:Female D020139:Gastroschisis D006801:Humans D007080:Ileocecal Valve D007223:Infant D007231:Infant, Newborn D007409:Intestinal Atresia D045822:Intestinal Volvulus D007422:Intestines D008297:Male D010288:Parenteral Nutrition D012189:Retrospective Studies D012778:Short Bowel Syndrome D015996:Survival Rate D016896:Treatment Outcome
Short bowel syndrome Etiology AGIR Bowel lengthening