WOFAPS 2025 8th World Congress of Pediatric Surgery

Jinfa Tou, Weicheng Zhang, Qi Qin, Xiaoxia Zhao, Dengming Lai

Children's Hospital Zhejiang University School of Medicine, Hangzhou, China

Background and Objectives: Pediatric short bowel syndrome (PSBS) results from the resection of a significant portion of the small intestine or congenital short bowel. This condition leads to a severe reduction in the effective digestive and absorptive area of the small intestine, failing to meet the normal nutritional needs of children. PSBS is a primary cause of intestinal failure in children, with main clinical manifestations including severe diarrhea and metabolic disorders. Most patients can achieve enteral autonomy (EA) through nutritional support and intestinal rehabilitation therapy, relying on intestinal adaptation. However, some patients remain unable to achieve this goal. Drugs such as glucagon-like peptide-2 (GLP-2) and its analogs provide an opportunity for intestinal growth in some PSBS patients who have reached a plateau stage, ultimately enabling them to achieve EA. However, some patients are insensitive to these drugs, or during treatment, they may experience severe intestinal dilation, abnormal intestinal motility, and small intestinal bacterial overgrowth, which can lead to recurrent enterogenic infections and require surgical intervention. Surgical treatments include intestinal transplantation and non-transplantation surgeries, the latter known as autologous intestinal reconstruction surgery (AIRS). Due to the shortage of donors, high rejection rates of allografts, and the need for lifelong immunosuppressive therapy, intestinal transplantation is not the first choice. Among AIRS, serial transverse enteroplasty (STEP) is the most widely applied, but it has limitations, particularly the requirement that the intestine be at least 4 cm dilated. For patients without intestinal dilation, segmental reversal of intestine (SRI) and colon interposition (CI) can be considered. However, their surgical outcomes are not well-documented. This study aims to evaluate the safety and effectiveness of SRI and CI by analyzing the preoperative and postoperative clinical data of PSBS patients.

Methods: From May 2017 to November 2024, a total of 16 PSBS patients in our hospital underwent SRI and CI. A retrospective analysis was conducted on these 16 children. Clinical data were collected, including clinical characteristics, surgical information, changes in parenteral nutrition (PN), complications, achievement of enteral autonomy, weight-for-age z score (WAZ), and changes in intestinal symptoms, to evaluate the safety and effectiveness of SRI and CI.

Results: A total of 16 PSBS patients who underwent SRI and CI were included in this study. The results showed that 10 patients underwent SRI, 2 patients underwent SRI and STEP, 2 patients underwent CI, 1 patient underwent CI + STEP, and 1 patient underwent SRI + CI. The male-to-female ratio was 9:7. The median length of the reversed intestine was 8.0 cm (IQR, 5.0-8.0 cm), and the average length of the interposed intestine was 19.3 ± 3.0 cm. Three patients (19%) developed perioperative complications, all of which resolved with conservative treatment. SRI and CI improved stool characteristics, reduced defecation frequency, and did not increase the frequency of enterogenic infections. At the last follow-up, 69% of the patients were able to wean off PN support and achieve EA. There was no significant difference in WAZ before and after surgery, and the intestinal transit time increased significantly in some patients. During follow-up, few non-specific complications were observed in the medium to long term, and most patients had a good prognosis. One patient who did not wean off PN after surgery underwent intestinal transplantation.

Conclusion: SRI and CI are safe and effective, providing a practical treatment option for some PSBS patients with complications or those who have reached the plateau stage of enteral nutrition. These procedures can improve intestinal symptoms and nutritional status in most patients, and many PSBS patients are expected to achieve EA. However, a small number of patients may still require PN support.