Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome

• Published in: Journal of pediatric surgery 2017-07, Vol.52 (7), p.1121-1127
• Main Authors: Hukkinen, Maria, Kivisaari, Reetta, Koivusalo, Antti, Pakarinen, Mikko P
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Conservative Treatment; Dilatation, Pathologic - etiology; Dilatation, Pathologic - surgery; Female; Follow-Up Studies; Humans; Infant; Intestinal failure; Intestine, Small - pathology; Intestine, Small - surgery; Logistic Models; Longitudinal intestinal lengthening and tapering; Male; Pediatrics; Retrospective Studies; Risk Factors; Serial transverse enteroplasty; Short bowel syndrome; Short Bowel Syndrome - pathology; Short Bowel Syndrome - surgery; Short Bowel Syndrome - therapy; Surgery; Tapering surgery; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2017.01.052

Abstract Background In remains unclear why in some short bowel syndrome (SBS) patients, the remaining small bowel (SB) dilates excessively leading to requirement of tapering surgery. Methods Among SBS children, we retrospectively analyzed risk factors for tapering surgery with logistic regression and compared the outcome of operated patients (n = 16) to those managed conservatively (n = 44) with Cox proportional hazards regression. Results SBS was due to necrotizing enterocolitis (NEC) (n = 31), SB atresia (SBA) (n = 13), midgut volvulus (n = 12), or gastroschisis (n = 4). Patients with spontaneous symptomatic SB dilatation unable to wean parenteral nutrition (PN) underwent tapering surgery at median age of 1.04 (interquartile range 0.70–3.27) years. Missing ICV was related with an 8-fold (p = 0.003) increased risk while SBA diagnosis with a 13-fold risk of tapering surgery (p < 0.001). Increasing SB length and NEC diagnosis were protective of tapering (p = 0.027–0.004). Of operated patients, 75% reached enteral autonomy during follow-up and their postoperative adjusted PN weaning rate was similar to non-operated children (p = 0.842). Conclusion SBS children with short remaining SB, missing ICV, and SBA etiology are more likely while NEC patients less likely than others to necessitate tapering surgery. Postoperative PN weaning rates were comparable to patients who initially had more favorable intestinal anatomy and adapted without surgery.