Surgical Options for Short Bowel Syndrome
The main goal of surgery for short bowel syndrome is to increase the capacity for absorption by the existing bowel. Surgery is considered in patients who are dependent long-term on parenteral nutrition when medications have failed and where the goal is to try to avoid intestinal transplantation.
Several different surgical procedures have been devised depending on the existing bowel length and function. The goal of these procedures is to improve function of the existing bowel by slowing transit or increasing surface area. Different methods include reconnecting remaining small bowel to the colon when continuity has been lost, attempting to increase transit time by reversing a segment of bowel, and intestinal lengthening procedures.
Intestinal transplantation becomes a necessary option when required life-long parenteral nutrition begins to fail. This is defined as significant evidence of liver injury, loss of central venous access, frequent line bloodstream infections (sepsis) which are becoming life threatening, and inability to keep up with excessive fluid loss (dehydration).
Isolated intestinal transplant is performed as the preferred procedure in patients who have adequate liver function. However, a combined liver and intestinal transplant is required for those with liver failure. Management strategies for intestinal transplantation, both before and after the operation, require careful consideration involving a multidisciplinary team of specialists available at only a few centers.