Eur J Pediatr Surg. 2021 Sep 17.doi: 10.1055/s-0041-1735163. Online ahead of print.

Javier Bueno ^1 2, Laura García-Martínez ¹, Susana Redecillas ¹, Oscar Segarra ¹, Manuel López ¹

Author information

¹Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.

²Department of Pediatric Surgery, Mother and Child University Hospital of Badajoz, Extremadura, Spain.

Abstract

Background: The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described.

Materials and methods: In this study, 16 children with SBS underwent MSTEP (2005-2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5).

Results: With a median follow-up of 5.8 years (0.7-13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines.

Conclusion: The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement