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Factors influencing enteral autonomy after autologous gastrointestinal reconstructive surgery: A two-centre UK perspective

      Highlights

      • 44% of patients achieved enteral autonomy (EA) following autologous gastrointestinal reconstructive (AGIR) surgery.
      • Percentage of expected of small bowel length (≥15%) before AGIR is a strong predictor of achievement of EA.
      • The AGIR technique employed did not influence weaning from parenteral nutrition.
      • Aetiology of short bowel syndrome (gastroschisis) can affect outcomes and a tailored, multi-disciplinary approach is recommended.

      Abstract

      Background and Aims

      The implementation of multidisciplinary care and improvements in parenteral nutrition (PN) in patients with short bowel syndrome (SBS) have led to better outcomes and higher survivability. Autologous gastrointestinal reconstructive (AGIR) surgery can reduce the duration on PN and lead to earlier enteral autonomy (EA). Our aim was to investigate the effect of SBS aetiology and other predictors on the achievement of enteral autonomy following AGIR surgery.

      Methods

      Retrospective review of all patients undergoing AGIR surgery in two tertiary paediatric surgical units, between 2010 and 2021. Continuous data is presented as median (range).

      Results

      Twenty-seven patients underwent 29 AGIR procedures (20 serial transverse enteroplasties (STEP), 9 longitudinal intestinal lengthening and tailoring (LILT)) at an age of 6.6 months (1.5 – 104.5). EA rate was 44% at 13.6 months after surgery (1 – 32.8). AGIR procedures achieved an increase in small bowel length of 70% (pre-operative 46.5 vs 77 cm, p = 0.003). No difference was found between STEP and LILT (p = 0.84). Percentage of expected small bowel length (based on the child's weight) was a strong predictor of EA (bowel length >15% – EA 80% vs bowel length ≤15% – EA 17%, p = 0.008). A diagnosis of gastroschisis showed a negative non-significant correlation with the ability to achieve EA (25% vs 60%, p = 0.12). Overall survival rate was 96%.

      Conclusion

      AGIR surgery is an important tool in the multidisciplinary management of children with SBS. Percentage of expected small length and aetiology of SBS are likely predictors of achievement of EA in patients undergoing AGIR surgery.

      Level of Evidence: IV

      Retrospective Case-Series

      Keywords

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