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The 2 STEP: an approach to repeating a serial transverse enteroplasty.
J Pediatr Surg. 2007 May; 42(5):819-22.JP

Abstract

PURPOSE

The serial transverse enteroplasty procedure (STEP) procedure is a successful and safe approach to lengthen small bowel in patients with short bowel syndrome (SBS). However, postlengthening dilatation may occur, which can lead to bacterial overgrowth and malabsorption. We addressed this problem by reperforming the STEP in 2 patients.

METHODS

Two infants underwent the STEP procedure at 3 days and at 4 months of life for SBS secondary to intestinal atresia and gastroschisis. The patients' small bowel lengths were 20 and 32 cm before and 25 and 52 cm after the initial STEP. Nine and 8.5 months afterward, the patients developed dilatation of the small bowel and feeding intolerance. A second STEP procedure was undertaken with additional transverse firings of staplers between previously lengthened segments and tapering of redundant blind-ending portions of bowel.

RESULTS

At operation, the bowel lengths were 45 and 62 cm. The second STEP left the patients with 61 and 73 cm of small bowel with a normalization of intestinal diameter. The first patient is doing well 5 months after surgery, and the second child tolerated increased enteral intake but died 1 year later from total parenteral nutrition-related liver failure.

CONCLUSIONS

This is the first report of a successful application of a second STEP procedure to further lengthen small bowel in SBS patients. Reapplication of the procedure requires careful stapling and a removal of small blind-ending segments to avoid further stasis.

Authors+Show Affiliations

Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17502191

Citation

Ehrlich, Peter F., et al. "The 2 STEP: an Approach to Repeating a Serial Transverse Enteroplasty." Journal of Pediatric Surgery, vol. 42, no. 5, 2007, pp. 819-22.
Ehrlich PF, Mychaliska GB, Teitelbaum DH. The 2 STEP: an approach to repeating a serial transverse enteroplasty. J Pediatr Surg. 2007;42(5):819-22.
Ehrlich, P. F., Mychaliska, G. B., & Teitelbaum, D. H. (2007). The 2 STEP: an approach to repeating a serial transverse enteroplasty. Journal of Pediatric Surgery, 42(5), 819-22.
Ehrlich PF, Mychaliska GB, Teitelbaum DH. The 2 STEP: an Approach to Repeating a Serial Transverse Enteroplasty. J Pediatr Surg. 2007;42(5):819-22. PubMed PMID: 17502191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The 2 STEP: an approach to repeating a serial transverse enteroplasty. AU - Ehrlich,Peter F, AU - Mychaliska,George B, AU - Teitelbaum,Daniel H, PY - 2007/5/16/pubmed PY - 2007/6/29/medline PY - 2007/5/16/entrez SP - 819 EP - 22 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 42 IS - 5 N2 - PURPOSE: The serial transverse enteroplasty procedure (STEP) procedure is a successful and safe approach to lengthen small bowel in patients with short bowel syndrome (SBS). However, postlengthening dilatation may occur, which can lead to bacterial overgrowth and malabsorption. We addressed this problem by reperforming the STEP in 2 patients. METHODS: Two infants underwent the STEP procedure at 3 days and at 4 months of life for SBS secondary to intestinal atresia and gastroschisis. The patients' small bowel lengths were 20 and 32 cm before and 25 and 52 cm after the initial STEP. Nine and 8.5 months afterward, the patients developed dilatation of the small bowel and feeding intolerance. A second STEP procedure was undertaken with additional transverse firings of staplers between previously lengthened segments and tapering of redundant blind-ending portions of bowel. RESULTS: At operation, the bowel lengths were 45 and 62 cm. The second STEP left the patients with 61 and 73 cm of small bowel with a normalization of intestinal diameter. The first patient is doing well 5 months after surgery, and the second child tolerated increased enteral intake but died 1 year later from total parenteral nutrition-related liver failure. CONCLUSIONS: This is the first report of a successful application of a second STEP procedure to further lengthen small bowel in SBS patients. Reapplication of the procedure requires careful stapling and a removal of small blind-ending segments to avoid further stasis. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/17502191/The_2_STEP:_an_approach_to_repeating_a_serial_transverse_enteroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(06)00972-9 DB - PRIME DP - Unbound Medicine ER -