Tags

Type your tag names separated by a space and hit enter

Repeat surgical bowel lengthening with the STEP procedure.
Transplantation. 2008 May 15; 85(9):1294-9.T

Abstract

BACKGROUND

Feasibility of repeat lengthening has been demonstrated in animals, but in humans, none of the three clinical case reports have achieved enteral autonomy after secondary lengthening with serial transverse enteroplasty (STEP).

PATIENTS AND METHODS

Institutional Review Board approved retrospective review of a single center series of repeat intestinal lengthening after prior Bianchi lengthening or STEP. Outcome measures examined include patient survival, weaning from parenteral nutrition, and need for intestinal transplantation.

RESULTS

Repeat lengthening with STEP was performed 16 times in 14 patients including 2 adults and 7 male patients after prior Bianchi (n=7) and prior STEP (n=7). Median time after initial lengthening to reSTEP was 12 months (2 months-15 years). Median remnant bowel length before initial lengthening was 35 cm (15-110), before reSTEP was 56.5 cm (27-100) and final length after reSTEP was 90 cm (39-120). Survival is 100% with a median follow-up of 14.5 months (1-65 months). Discontinuation of parenteral nutrition (PN) after reSTEP was achieved in 6 of 14 (43%) patients at a median of 3 months (0.5-13 months) after reSTEP. Intestinal transplant salvage was performed in four patients at 7, 9, 13 months, and 4.6 years, respectively, after reSTEP. All four of those undergoing intestinal transplantation have also subsequently discontinued PN.

CONCLUSIONS

Repeat lengthening is technically feasible after either of the available surgical lengthening procedures (Bianchi and STEP). In the stable patient, who is unable to wean from PN, repeat lengthening led to discontinuation of TPN in almost half of these carefully selected patients and does not preclude intestinal transplantation.

Authors+Show Affiliations

University of Nebraska Medical Center, Transplant Surgery, 983285 Nebraska medical Center, Omaha, NE 68198-6555, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18475187

Citation

Andres, Ane M., et al. "Repeat Surgical Bowel Lengthening With the STEP Procedure." Transplantation, vol. 85, no. 9, 2008, pp. 1294-9.
Andres AM, Thompson J, Grant W, et al. Repeat surgical bowel lengthening with the STEP procedure. Transplantation. 2008;85(9):1294-9.
Andres, A. M., Thompson, J., Grant, W., Botha, J., Sunderman, B., Antonson, D., Langnas, A., & Sudan, D. (2008). Repeat surgical bowel lengthening with the STEP procedure. Transplantation, 85(9), 1294-9. https://doi.org/10.1097/TP.0b013e31817268ca
Andres AM, et al. Repeat Surgical Bowel Lengthening With the STEP Procedure. Transplantation. 2008 May 15;85(9):1294-9. PubMed PMID: 18475187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repeat surgical bowel lengthening with the STEP procedure. AU - Andres,Ane M, AU - Thompson,Jon, AU - Grant,Wendy, AU - Botha,Jean, AU - Sunderman,Brandy, AU - Antonson,Dean, AU - Langnas,Alan, AU - Sudan,Debra, PY - 2008/5/14/pubmed PY - 2008/8/1/medline PY - 2008/5/14/entrez SP - 1294 EP - 9 JF - Transplantation JO - Transplantation VL - 85 IS - 9 N2 - BACKGROUND: Feasibility of repeat lengthening has been demonstrated in animals, but in humans, none of the three clinical case reports have achieved enteral autonomy after secondary lengthening with serial transverse enteroplasty (STEP). PATIENTS AND METHODS: Institutional Review Board approved retrospective review of a single center series of repeat intestinal lengthening after prior Bianchi lengthening or STEP. Outcome measures examined include patient survival, weaning from parenteral nutrition, and need for intestinal transplantation. RESULTS: Repeat lengthening with STEP was performed 16 times in 14 patients including 2 adults and 7 male patients after prior Bianchi (n=7) and prior STEP (n=7). Median time after initial lengthening to reSTEP was 12 months (2 months-15 years). Median remnant bowel length before initial lengthening was 35 cm (15-110), before reSTEP was 56.5 cm (27-100) and final length after reSTEP was 90 cm (39-120). Survival is 100% with a median follow-up of 14.5 months (1-65 months). Discontinuation of parenteral nutrition (PN) after reSTEP was achieved in 6 of 14 (43%) patients at a median of 3 months (0.5-13 months) after reSTEP. Intestinal transplant salvage was performed in four patients at 7, 9, 13 months, and 4.6 years, respectively, after reSTEP. All four of those undergoing intestinal transplantation have also subsequently discontinued PN. CONCLUSIONS: Repeat lengthening is technically feasible after either of the available surgical lengthening procedures (Bianchi and STEP). In the stable patient, who is unable to wean from PN, repeat lengthening led to discontinuation of TPN in almost half of these carefully selected patients and does not preclude intestinal transplantation. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/18475187/Repeat_surgical_bowel_lengthening_with_the_STEP_procedure_ L2 - https://doi.org/10.1097/TP.0b013e31817268ca DB - PRIME DP - Unbound Medicine ER -