Surgical Options in Short Bowel Syndrome

Short bowel syndrome is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection, intestinal intrinsic disease or surgical bypass. The main complications are mal-digestion, malnutrition, dehydration and, potentially, lethal lesions. The management, based on appropriate and individualized nutritional support, is complexand requires a multidisciplinary approach including dietary, fluid and pharmacological management, co-morbid disease management and, sometimes, surgery. Numerous surgical procedures to relieve the consequences of massive intestinal resection have been devised, but many have not been employed in human clinics and have remained in the experimental surgery field. The choice of technique is dictated by the patient ́s underlying pathophysiology and includes such factors as age, intestinal transit time, length of remnant bowel, presence of intact colon, degree of small bowel dilation, and others. Autologous intestinal reconstruction includes various techniques which manipulate the bowel surgically to facilitate the bowel adaptation process and restoration of enteral nutrition. The most accepted techniques are those elongating the bowel that may be applied only on dilated bowel. However, the intestinal transplantation can be a curative alternative for patients in whom intestinal rehabilitation attempts have failed and who are at risk of life-threatening parenteral nutrition complications