TY - JOUR
T1 - Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review
AU - Nagelkerke, Sjoerd C. J.
AU - Poelgeest, M. Y. Van
AU - Wessel, L. M.
AU - Mutanen, A.
AU - Langeveld, H. R.
AU - Hill, S.
AU - Benninga, M. A.
AU - Tabbers, M. M.
AU - Bakx, R.
N1 - Publisher Copyright: © 2021 Cambridge University Press. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Introduction ?The aims of the study are to systematically assess and critically appraise the evidence concerning two surgical techniques to lengthen the bowel in children with short bowel syndrome (SBS), namely, the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP), and to identify patient characteristics associated with a favorable outcome. Materials and Methods ?MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception till December 2019. No language restriction was used. Results ?In all, 2,390 articles were found, of which 40 were included, discussing 782 patients. The median age of the patients at the primary bowel lengthening procedure was 16 months (range: 1-84 months). Meta-analysis could not be performed due to the incomparability of the groups, due to heterogeneous definitions and outcome reporting. After STEP, 46% of patients weaned off parenteral nutrition (PN) versus 52% after LILT. Mortality was 7% for STEP and 26% for LILT. Patient characteristics predictive for success (weaning or survival) were discussed in nine studies showing differing results. Quality of reporting was considered poor to fair. Conclusion ?LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. Homogenous, prospective, outcome reporting is necessary, for which an international network is needed.
AB - Introduction ?The aims of the study are to systematically assess and critically appraise the evidence concerning two surgical techniques to lengthen the bowel in children with short bowel syndrome (SBS), namely, the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP), and to identify patient characteristics associated with a favorable outcome. Materials and Methods ?MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception till December 2019. No language restriction was used. Results ?In all, 2,390 articles were found, of which 40 were included, discussing 782 patients. The median age of the patients at the primary bowel lengthening procedure was 16 months (range: 1-84 months). Meta-analysis could not be performed due to the incomparability of the groups, due to heterogeneous definitions and outcome reporting. After STEP, 46% of patients weaned off parenteral nutrition (PN) versus 52% after LILT. Mortality was 7% for STEP and 26% for LILT. Patient characteristics predictive for success (weaning or survival) were discussed in nine studies showing differing results. Quality of reporting was considered poor to fair. Conclusion ?LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. Homogenous, prospective, outcome reporting is necessary, for which an international network is needed.
KW - Bianchi
KW - intestinal failure
KW - longitudinal intestinal lengthening and tailoring
KW - pediatric
KW - serial transverse enteroplasty
UR - http://www.scopus.com/inward/record.url?scp=85102284563&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/s-0041-1725187
DO - https://doi.org/10.1055/s-0041-1725187
M3 - Review article
C2 - 33663008
SN - 0939-7248
JO - European journal of pediatric surgery
JF - European journal of pediatric surgery
ER -