J Pediatr Surg. 2021 Apr;56(4):733-737. doi: 10.1016/j.jpedsurg.2020.06.045. Epub 2020 Jul 10.

David F Mercer ¹, Tyler R Burnett ², Brandy D Hobson ³, Samantha J Logan ³, Brandi K Gerhardt ², Sarah N Iwansky ², Ruben E Quiros-Tejeira ⁴

Author information

• ¹Department of Surgery, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE, USA 68198-3285. Electronic address: dmercer@unmc.edu.
• ²Department of Surgery, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE, USA 68198-3285.
• ³Department of Clinical Nutrition, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE, USA 68198-3285.
• ⁴Department of Pediatrics, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE, USA 68198-3285.

Abstract

Background/purpose: Following a serial transverse enteroplasty (STEP) procedure some children develop redilation of the small intestine leading to impaired enteral tolerance and inability to wean parenteral nutrition (PN). The benefit of a second STEP procedure (2STEP) has been controversial.

Methods: We performed a retrospective review of our experience (2008-2018) performing 2STEP, with comparative analysis of nutritional outcomes pre- and postsurgery.

Results: During this period 2STEP was performed in 23 patients (13 F:10 M) at a median (25%-75%) age of 2.2 (1.2-3.6) years. Median intestinal length was 68 (40-105) cm before and 85 (40-128) cm after 2STEP. Leading up to 2STEP, PN provided almost 75% of estimated calorie needs. By 24 weeks following 2STEP drops in mean PN percent approached statistical significance (p = 0.07) and at most recent follow up the mean PN percentage was statistically better than at the time of operation or 4 weeks prior to 2STEP, and was nearly significant compared with 12 weeks (p = 0.07) and 24 weeks (p = 0.06) prior. Thirteen children were completely off parenteral support.

Conclusion: When small intestine redilation occurs following a STEP procedure and where PN cannot otherwise be weaned we believe these data support performing a 2STEP. We cannot predict preoperatively which children will ultimately benefit.

Level of evidence: 3 (retrospective comparative study).