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Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature.
J Pediatr Surg. 2013 Aug; 48(8):1794-805.JP

Abstract

PURPOSE

To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data.

METHODS

A review of literature was performed. N=39 publications were reviewed.

RESULTS

For LILT and STEP, failure to achieve intestinal autonomy by conservative therapy represents the main indication, and end-stage liver disease the main contraindication. A sufficiently dilated intestinal segment is a common anatomical precondition for both procedures. STEP can be performed on shorter intestinal segments and on intricate segments such as the duodenum, which is technically not feasible for LILT. Both procedures have a similar extent of intestinal lengthening (approximately 70%) and result in improvement of enteral nutrition and reversal of complications of parenteral nutrition. STEP seems to have a lower mortality and overall progression to transplantation.

CONCLUSIONS

STEP and LILT are both accepted procedures for non-transplant surgical management of SBS in children. The outcome after STEP seems to be more favourable, but larger series are needed to further assess accurate selection of eligible patients and to estimate effectiveness of procedures. A considerably higher number of cases for evaluation might be accomplished through the widespread use of a centralised registry.

Authors+Show Affiliations

Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23932625

Citation

Frongia, Giovanni, et al. "Comparison of LILT and STEP Procedures in Children With Short Bowel Syndrome -- a Systematic Review of the Literature." Journal of Pediatric Surgery, vol. 48, no. 8, 2013, pp. 1794-805.
Frongia G, Kessler M, Weih S, et al. Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature. J Pediatr Surg. 2013;48(8):1794-805.
Frongia, G., Kessler, M., Weih, S., Nickkholgh, A., Mehrabi, A., & Holland-Cunz, S. (2013). Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature. Journal of Pediatric Surgery, 48(8), 1794-805. https://doi.org/10.1016/j.jpedsurg.2013.05.018
Frongia G, et al. Comparison of LILT and STEP Procedures in Children With Short Bowel Syndrome -- a Systematic Review of the Literature. J Pediatr Surg. 2013;48(8):1794-805. PubMed PMID: 23932625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature. AU - Frongia,Giovanni, AU - Kessler,Markus, AU - Weih,Sandra, AU - Nickkholgh,Arash, AU - Mehrabi,Arianeb, AU - Holland-Cunz,Stefan, PY - 2013/01/16/received PY - 2013/03/02/revised PY - 2013/05/21/accepted PY - 2013/8/13/entrez PY - 2013/8/13/pubmed PY - 2014/4/15/medline KW - AIRS KW - Autologous Intestinal Reconstruction Surgery KW - Autologous intestinal reconstruction KW - Bianchi KW - Intestinal lengthening KW - LILT KW - Longitudinal Intestinal Lengthening and Tailoring KW - Not reported KW - PN KW - Parenteral Nutrition KW - SBS KW - SBTX KW - STEP KW - STP KW - Serial Transverse Enteroplasty KW - Short Bowel Syndrome KW - Short Bowel Transplantation KW - Short bowel syndrome KW - n.r SP - 1794 EP - 805 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 48 IS - 8 N2 - PURPOSE: To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data. METHODS: A review of literature was performed. N=39 publications were reviewed. RESULTS: For LILT and STEP, failure to achieve intestinal autonomy by conservative therapy represents the main indication, and end-stage liver disease the main contraindication. A sufficiently dilated intestinal segment is a common anatomical precondition for both procedures. STEP can be performed on shorter intestinal segments and on intricate segments such as the duodenum, which is technically not feasible for LILT. Both procedures have a similar extent of intestinal lengthening (approximately 70%) and result in improvement of enteral nutrition and reversal of complications of parenteral nutrition. STEP seems to have a lower mortality and overall progression to transplantation. CONCLUSIONS: STEP and LILT are both accepted procedures for non-transplant surgical management of SBS in children. The outcome after STEP seems to be more favourable, but larger series are needed to further assess accurate selection of eligible patients and to estimate effectiveness of procedures. A considerably higher number of cases for evaluation might be accomplished through the widespread use of a centralised registry. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/23932625/Comparison_of_LILT_and_STEP_procedures_in_children_with_short_bowel_syndrome____a_systematic_review_of_the_literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(13)00430-2 DB - PRIME DP - Unbound Medicine ER -